挪威肾移植受者的妊娠结局。妊娠前免疫抑制药物治疗方案和健康状况的重要性。

Pregnancy outcome in renal allograft recipients in Norway. The importance of immunosuppressive drug regimen and health status before pregnancy.

作者信息

Haugen G, Fauchald P, Sødal G, Leivestad T, Moe N

机构信息

Department of Obstetrics and Gynecology, National Hospital, University of Oslo, Norway.

出版信息

Acta Obstet Gynecol Scand. 1994 Aug;73(7):541-6. doi: 10.3109/00016349409006270.

DOI:10.3109/00016349409006270

PMID:8079604

Abstract

BACKGROUND

To study the influence of pre-conceptional health status and immunosuppressive drug regimen on pregnancy outcome in renal allograft recipients.

METHODS

The study includes all pregnancies in renal allograft recipients in Norway in the period 1973-1991. The data were collected from the patient records. Serum-creatinine values, proteinuria, blood pressure, recent graft rejection, and immunosuppressive drug regimen before pregnancy as well as the interval from transplantation until pregnancy were related to the frequency of deliveries at term, preterm deliveries, and of induced and spontaneous abortions.

RESULTS

54 pregnancies in 37 renal allograft recipients resulted in 31 term deliveries, 12 preterm deliveries, four spontaneous, and seven induced abortions. One induced abortion due to psychosocial reasons was excluded from the calculations. Post-transplant intervals less than two years as compared to longer intervals were associated with an increased frequency of spontaneous and induced abortions (6/13 vs 4/40, p < 0.01) and a non-significant increase in the relation between preterm and term deliveries (3/4 vs 9/27). The few women with proteinuria, elevated serum-creatinine values, and hypertension before pregnancy had an increased number of adverse pregnancy results. The women receiving cyclosporine A experienced a larger frequency of spontaneous and induced abortions (7/18 vs 3/35, p < 0.05) and an increase in the relation between preterm and term deliveries (7/4 vs 5/27, p < 0.01) as compared to the women who received prednisolone and azathioprine only.

CONCLUSIONS

The results demonstrate the importance of pre-conceptional consultation and may indicate a harmful effect of cyclosporine A on pregnancy outcome.

摘要

背景

研究肾移植受者孕前健康状况和免疫抑制药物方案对妊娠结局的影响。

方法

该研究纳入了1973年至1991年期间挪威肾移植受者的所有妊娠情况。数据从患者记录中收集。将血清肌酐值、蛋白尿、血压、近期移植肾排斥反应、孕前免疫抑制药物方案以及从移植到妊娠的间隔时间与足月分娩、早产、人工流产和自然流产的频率相关联。

结果

37名肾移植受者的54次妊娠导致31次足月分娩、12次早产、4次自然流产和7次人工流产。因社会心理原因进行的1次人工流产被排除在计算之外。与较长间隔相比，移植后间隔小于两年与自然流产和人工流产频率增加相关（6/13对4/40，p<0.01），早产与足月分娩的关系也有非显著性增加（3/4对9/27）。少数孕前有蛋白尿、血清肌酐值升高和高血压的女性不良妊娠结果增多。与仅接受泼尼松龙和硫唑嘌呤的女性相比，接受环孢素A的女性自然流产和人工流产频率更高（7/18对3/35，p<0.05），早产与足月分娩的关系也增加（7/4对5/27，p<0.01）。