Introduction: Pregnancy after kidney transplantation may be associated with maternal, fetal complications. In our study, we evaluated the outcome of pregnancy after kidney transplantation.

Methods: Retrospective cohort study conducted on 236 patients out of 3000 kidney transplant recipients who underwent kidney transplantation at Mansoura Urology and Nephrology Centre between March 1976 and December 2019, divided into two groups, group I; 118 kidney transplant recipients experienced pregnancy after kidney transplantation and Group II; 118 kidney transplant recipients who didn't experience pregnancy after kidney transplantation.

Results: frequency of pregnancy in our center is 191 pregnancies in 118 women after kidney transplantation between 1976 and 2019. We found the mean pregnancy age between (26.27- 29.89), the mean gestational age between (33.69- 33) weeks. The live birth rate is 126 (66%). Preterm delivery rate is 85 (44.5%), neonatal death 8 (4.1%), miscarriage 59 (30.9%), intrauterine fetal death 6 (3.1%) and birth defect 4 (2%). The frequency rates of gestational hypertension is 87 (45.5%), pre-eclampsia 48 (25.1%), gestational diabetes 19 (9.9%), and urinary tract infection 36 (18.8%). Cesarean section is the most common method of delivery in our study 133 (69.6%).

Conclusions: The risks of maternal and fetal complications are high among pregnant kidney transplant recipients, including pregnancy-induced hypertension, increased pre-eclampsia rates, gestational diabetes, and cesarean section rates. Serum creatinine and 24-hour urinary protein tend to increase during and after pregnancy which may impair the graft outcome. Pregnancy counseling is necessary to avoid high-risk or unwanted pregnancies.