{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T06:40:32Z","timestamp":1792305632629,"version":"4.4.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2025,6]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Women with kidney transplantation had higher rates of cesarean sections, deliveries without labor, and vaginal delivery complications.<\/jats:p>\n <\/jats:list-item>\n \n Women with a kidney transplant had more cesarean sections, even after accounting for maternal factors, preterm delivery, and past cesarean sections.<\/jats:p>\n <\/jats:list-item>\n \n Hypertensive disorders of pregnancy and breech presentation were the main drivers of planned cesarean section delivery among transplant recipients.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Factors influencing high cesarean section rates among mothers with a kidney transplant remain unclear.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Using linked Australia and New Zealand Dialysis and Transplant Registry (1970\u20132016) and perinatal datasets (1991\u20132013), we compared deliveries of women with a functioning kidney transplant with those without KRT (non-KRT).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 2,946,851 babies (1,627,408 mothers), 211 were born to 137 mothers with a kidney transplant. Overall cesarean section rates were twice more frequent in the transplant cohort (63% versus 26% non-KRT;\n P<\/jats:italic>\n < 0.001) across all gestational periods compared with the non-KRT cohort and highest in preterm births (\u226537 weeks, 48% versus 25%;\n P<\/jats:italic>\n < 0.001, 33\u201336 weeks, 77% versus 40%;\n P<\/jats:italic>\n < 0.001, and <33 weeks, 75% versus 41%;\n P<\/jats:italic>\n < 0.001). Cesarean section rates remained higher after adjusting for maternal factors (incidence rate ratio, 1.5; 95% confidence interval, 1.3 to 1.7). In women with a kidney transplant with past pregnancy, 53% with no previous cesarean sections had a cesarean section in the current pregnancy (versus 19% non-KRT;\n P<\/jats:italic>\n < 0.001). Mothers with a kidney transplant had less spontaneous labor (30% versus 63%;\n P<\/jats:italic>\n < 0.001) and more planned deliveries (induced or elective cesarean sections; 70% versus 36%;\n P<\/jats:italic>\n < 0.001) than non-KRT mothers. Nearly half of the women with transplantation (45%) delivered by nonlabor cesarean sections, mostly occurring preterm (<37 weeks, 70% versus \u226537 weeks, 30%;\n P<\/jats:italic>\n = 0.002). In the transplant cohort, the main indications for nonlabor cesarean sections were hypertensive disorders of pregnancy and breech presentation (>50% versus 18% non-KRT cohort;\n P<\/jats:italic>\n < 0.001) and were linked to gestational age. Nonlabor cesarean sections for fetal distress were higher in women with transplantation (10% versus 4% non-KRT;\n P<\/jats:italic>\n = 0.03). In the non-KRT cohort, previous cesarean sections were the main indication for nonlabor cesarean sections (40% versus 24% transplant;\n P<\/jats:italic>\n = 0.06).\n Postpartum<\/jats:italic>\n hemorrhage (13% versus 7% non-KRT;\n P<\/jats:italic>\n = 0.003) and fetal distress (18% versus 10% non-KRT;\n P<\/jats:italic>\n = 0.001) were higher among the transplant cohort.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Women with a kidney transplant have higher rates of cesarean section delivery even after accounting for maternal factors, preterm delivery, and past cesarean sections compared with non-KRT cohorts.<\/jats:p>\n <\/jats:sec>\n \n Podcast<\/jats:title>\n This article contains a podcast at https:\/\/dts.podtrac.com\/redirect.mp3\/\/www.asn-online.org\/media\/podcast\/JASN\/2026_02_09_KTS_February2026.mp3<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.0000000559","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T15:02:34Z","timestamp":1732546954000},"page":"1152-1163","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Labor and Delivery Outcomes in Australian Mothers after Kidney Transplantation"],"prefix":"10.1681","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6982-1013","authenticated-orcid":false,"given":"Nishanta","family":"Tangirala","sequence":"first","affiliation":[{"name":"Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia"},{"name":"Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8320-3668","authenticated-orcid":false,"given":"Erandi","family":"Hewawasam","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E.","family":"Davies","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6162-0305","authenticated-orcid":false,"given":"Amanda","family":"Poprzeczny","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Women's and Babies Division, Department of Obstetrics and Gynaecology, Women\u2019s and Children\u2019s Hospital, Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-2753","authenticated-orcid":false,"given":"Elizabeth","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6103-1386","authenticated-orcid":false,"given":"Stephen P.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia"},{"name":"Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9695-0761","authenticated-orcid":false,"given":"Shilpanjali","family":"Jesudason","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia"},{"name":"Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, 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