Silvi Shah, MD, MS, is a tenured associate professor and an NIH-funded physician-scientist in the Division of Nephrology at the University of Cincinnati, Ohio. Dr. Shah completed her general nephrology fellowship from the Cleveland Clinic Foundation, Ohio, a transplant nephrology fellowship at the University of Alabama in Birmingham, and a master's in clinical and translation research from the University of Cincinnati.
Dr. Shah's research focuses on women’s health, including pregnancy, sex disparities, health equity, and cardiovascular health with kidney disease. She is a recipient of the K23 Career Development Award from the National Institutes of Health. Dr. Shah has led groundbreaking work that identified a high pregnancy incidence in women with kidney failure undergoing dialysis, published in the high-impact Journal of the American Society of Nephrology. Dr. Shah has authored over 60 peer-reviewed manuscripts. She is an associate editor for Advances in Kidney Disease and Health journal and serves on the editorial board of JASN, CJASN, and Kidney 360 journals. Dr. Shah is chair-elect for the American Heart Association’s “Kidney in Cardiovascular Disease” SCILL committee and leads the American Society of Nephrology’s “Women’s Health and Research in Nephrology” community. She has served as the executive member of the American Society of Transplantation’s “Women’s Health Community of Practice” and as the councilor in the Women in Nephrology.
Pregnancy outcomes after kidney transplant utilizing assisted reproductive technologies
Silvi Shah1, Brenna Rachwal1, Prema Vyas6, Pragati Basera1, Swathi Rao4, Anthony Leonard1, Prasoon Verma3, Serban Constantinescu2, Michael Moritz2, Shilpanjali Jesudason5, Lisa Coscia2.
1Nephrology, University of Cincinnati, Cincinnati, OH, United States; 2Transplantation Pregnancy Registry International, Gift of Life Institute, Philadelphia, PA, United States; 3Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States; 4Nephrology, University of Virginnia, Charlottesville, VA, United States; 5Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; 6Burnett School of Medicine at Texas Christian University, Fort Worth, TX, United States
Background: Infertility is common among those with kidney transplants, and pregnancy is associated with a high risk of adverse maternal and fetal outcomes. Little is known about pregnancy outcomes following conceptions utilizing assisted reproductive technologies after kidney transplants.
Methods: This was a retrospective cohort study of adult kidney transplant recipients who received their graft between 1968 and 2022 with a subsequent pregnancy enrolled in the Transplant Pregnancy Registry International. This study aimed to define characteristics and outcomes in pregnancy in kidney transplant recipients with assisted reproductive technologies (ART), defined by the use of in-vitro fertilization, intrauterine insemination, and medications to stimulate ovulation. Univariable and multivariable logistic regression analyses were constructed to compare pregnancy outcomes with ART versus natural conception.
Results: There were 122 pregnancies utilizing ART in 94 kidney transplant recipients. The mean age at the time of conception was 34.0 ± 5.5 years. ART pregnancies were associated with a higher adjusted likelihood of drug-treated hypertension (OR, 1.66; CI, 1.12-2.48), a higher adjusted likelihood of cesarean delivery (OR, 1.58; CI, 1.01-2.48), and a higher adjusted risk of preterm births <37 weeks. (OR, 1.79; CI, 1.16-2.76), as compared to natural conception pregnancies. The proportion of live births did not differ, but pregnancies with ART had a lower mean birth weight (2303 ± 793.8 grams vs. 2620 ± 752.9 grams) and a lower mean gestational age as compared to the natural conception pregnancies (35.1 ± 3.3 weeks vs. 36.0 ±± 3.3 weeks). There were no differences in the likelihood of gestational diabetes, preeclampsia, low birth weights, miscarriages, or birth defects between ART and natural conception pregnancies. There was no difference in risk of rejection during pregnancy nor in 2-year graft loss following delivery in those who conceived with ART vs. those with natural conception.
Conclusion: Pregnancies conceived by ART are associated with a higher risk of preterm births, hypertension during pregnancy, and cesarean delivery compared to naturally conceived pregnancies. Live birth rate and 2-year graft loss did not differ. This knowledge can assist healthcare providers in preconception counseling kidney transplant recipients regarding the use of ART.
[1] Pregnancy
[2] Kidney Transplant
[3] Assisted Reproductive Technologies
[4] Outcomes
