{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T04:29:02Z","timestamp":1792297742373,"version":"4.4.0"},"reference-count":128,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,9,26]],"date-time":"2021-09-26T00:00:00Z","timestamp":1632614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Pregnancy is not contraindicated in kidney transplant women but entails risks of maternal and fetal complications. Three main conditions can influence the outcome of pregnancy in transplant women: preconception counseling, maternal medical management, and correct use of drugs to prevent fetal toxicity. Preconception counseling is needed to prevent the risks of an unplanned untimely pregnancy. Pregnancy should be planned \u22652 years after transplantation. The candidate for pregnancy should have normal blood pressure, stable serum creatinine &lt;1.5 mg\/dL, and proteinuria &lt;500 mg\/24 h. Maternal medical management is critical for early detection and treatment of complications such as hypertension, preeclampsia, thrombotic microangiopathy, graft dysfunction, gestational diabetes, and infection. These adverse outcomes are strongly related to the degree of kidney dysfunction. A major issue is represented by the potential fetotoxicity of drugs. Moderate doses of glucocorticoids, azathioprine, and mTOR inhibitors are relatively safe. Calcineurin inhibitors (CNIs) are not associated with teratogenicity but may increase the risk of low birth weight. Rituximab and eculizumab should be used in pregnancy only if the benefits outweigh the risk for the fetus. Renin\u2013angiotensin system inhibitors, mycophenolate, bortezomib, and cyclophosphamide can lead to fetal toxicity and should not be prescribed to pregnant women.<\/jats:p>","DOI":"10.3390\/jpm11100956","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T04:55:33Z","timestamp":1632718533000},"page":"956","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Planned Pregnancy in Kidney Transplantation. A Calculated Risk"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6060-965X","authenticated-orcid":false,"given":"Claudio","family":"Ponticelli","sequence":"first","affiliation":[{"name":"Nephrology, Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Zaina","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Moroni","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ijgo.2003.09.013","article-title":"Menstrual characteristics and pregnancy in women after renal transplantation","volume":"85","author":"Pezeshki","year":"2004","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.mcna.2016.01.010","article-title":"Long-Term Functional Recovery, Quality of Life, and Pregnancy After Solid Organ Transplantation","volume":"100","author":"Rao","year":"2016","journal-title":"Med. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1111\/ajt.14697","article-title":"Reproductive health in women following abdominal organ transplant","volume":"18","author":"Sarkar","year":"2018","journal-title":"Am. J. Transpl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.1097\/TP.0000000000001645","article-title":"Outcomes of Pregnancies After Kidney Transplantation: Lessons Learned From CKD. A Comparison of Transplanted, Nontransplanted Chronic Kidney Disease Patients and Low-Risk Pregnancies: A Multicenter Nationwide Analysis","volume":"101","author":"Piccoli","year":"2017","journal-title":"Transplantation"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Shah, S., Venkatesan, R.L., Gupta, A., Sanghavi, M.K., Welge, J., Johansen, R., Kean, E.B., Kaur, T., Gupta, A., and Grant, T.J. (2019). Pregnancy outcomes in women with kidney transplant: Metaanalysis and systematic review. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1213-5"},{"key":"ref_6","first-page":"2243","article-title":"Pregnancy in patients with underlying renal disease","volume":"Volume 3","author":"Davison","year":"2005","journal-title":"Oxford Textbook of Clinical Nephrology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1111\/j.1600-6143.2005.00969.x","article-title":"Reproduction and transplantation: Report on the AST Consensus Conference on Reproductive Issues and Transplantation","volume":"5","author":"McKay","year":"2005","journal-title":"Am. J. Transpl."},{"key":"ref_8","unstructured":"Coscia, L.A., Constantinescu, S., Moritz, M.J., Frank, A.M., Ramirez, C.B., Maley, W.R., Doria, C., McGrory, C.H., and Armenti, V.T. (2010). Report from the National Transplantation Pregnancy Registry (NTPR): Outcomes of pregnancy after transplantation. Clin. Transpl., 65\u201385."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1161\/HYPERTENSIONAHA.119.14280","article-title":"Hypertensive Complications of Pregnancy and Risk of Venous Thromboembolism","volume":"75","author":"Scheres","year":"2020","journal-title":"Hypertension"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5298","DOI":"10.1136\/bmj.f5298","article-title":"Different combined oral contraceptives and the risk of venous thrombosis: Systematic review and network meta-analysis","volume":"347","author":"Stegeman","year":"2013","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.contraception.2010.02.007","article-title":"Contraceptive use among solid organ transplant patients: A systematic review","volume":"82","author":"Paulen","year":"2010","journal-title":"Contraception"},{"key":"ref_12","first-page":"252","article-title":"Contraception After Kidney Transplantation, From Myth to Reality: A Comprehensive Review of the Current Evidence","volume":"14","author":"Yousif","year":"2016","journal-title":"Exp. Clin. Transpl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.contraception.2016.11.008","article-title":"Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: A case series","volume":"95","author":"Huguelet","year":"2017","journal-title":"Contraception"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e325","DOI":"10.1097\/TP.0000000000002903","article-title":"Immunosuppression and Reproductive Health After Kidney Transplantation","volume":"103","author":"Chandra","year":"2019","journal-title":"Transplantation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1007\/s40620-020-00717-0","article-title":"Contraception in chronic kidney disease: A best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology","volume":"33","author":"Attini","year":"2020","journal-title":"J. Nephrol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S117","DOI":"10.2215\/CJN.02980707","article-title":"Pregnancy after transplantation","volume":"3","author":"McKay","year":"2008","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1111\/ajt.13773","article-title":"Timing of pregnancy after kidney transplantation and risk of allograft failure","volume":"16","author":"Rose","year":"2016","journal-title":"Am. J. Transpl."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"EBPG Expert Group on Renal Transplantation (2002). European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.10. Pregnancy in renal transplant recipients. Nephrol. Dial. Transpl., 17, 50\u201355.","DOI":"10.1093\/ndt\/17.suppl_4.50"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1046\/j.1341-8076.2003.00106.x","article-title":"Pregnancy after transplantation","volume":"29","author":"Davison","year":"2003","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s40620-018-0499-x","article-title":"A best-practice position statement on pregnancy after kidney transplantation: Focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology","volume":"31","author":"Cabiddu","year":"2018","journal-title":"J. Nephrol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e13563","DOI":"10.1111\/ctr.13563","article-title":"AST ID Community of Practice. Vaccination of solid organ transplant candidates and recipients: Guidelines from the American society of transplantation infectious diseases community of practice","volume":"33","author":"Kumar","year":"2019","journal-title":"Clin. Transpl."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.eururo.2020.03.039","article-title":"Coronavirus Disease 2019 pneumonia in immunosuppressed renal transplant recipients: A summary of 10 confirmed cases in Wuhan China","volume":"77","author":"Zhu","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.kint.2020.03.018","article-title":"COVID-19 infection in kidney transplant recipients","volume":"97","author":"Banerjee","year":"2020","journal-title":"Kidney Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.kint.2020.04.002","article-title":"A single center observational study of the clinical characteristics and short-term outcome of 20 kidney transplant patients admitted for SARS-CoV2 pneumonia","volume":"97","author":"Alberici","year":"2020","journal-title":"Kidney Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1111\/ajt.16424","article-title":"Is COVID-19 infection more severe in kidney transplant recipients?","volume":"21","author":"Caillard","year":"2021","journal-title":"Am. J. Transpl."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/S1473-3099(20)30764-7","article-title":"Genomic evidence for reinfection with SARS-CoV-2: A case study","volume":"21","author":"Tillett","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1681\/ASN.2014050459","article-title":"Risk of Adverse Pregnancy Outcomes in Women with CKD","volume":"26","author":"Piccoli","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/j.1600-0897.2010.00836.x","article-title":"The immune system in pregnancy: A unique complexity","volume":"63","author":"Mor","year":"2010","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1038\/ncpneph0781","article-title":"Urinary tract infection in the renal transplant patient","volume":"4","author":"Olsburgh","year":"2008","journal-title":"Nat. Clin. Pract. Nephrol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e12192","DOI":"10.1097\/MD.0000000000012192","article-title":"The association between urinary tract infection during pregnancy and preeclampsia: A meta-analysis","volume":"97","author":"Yan","year":"2018","journal-title":"Medicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.ajog.2020.02.018","article-title":"Cytomegalovirus infection during pregnancy: State of the science","volume":"223","author":"Foulon","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/j.1432-2277.2011.01242.x","article-title":"Hypertension in kidney transplant recipients","volume":"24","author":"Ponticelli","year":"2011","journal-title":"Transpl. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1053\/j.ackd.2010.10.006","article-title":"Hypertension following kidney transplantation","volume":"18","author":"Rubin","year":"2011","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1097\/AOG.0b013e318187d00c","article-title":"Society for Maternal-Fetal Medicine, authors. Pregnancy after solid organ transplantation","volume":"112","author":"Mastrobattista","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2388","DOI":"10.1111\/j.1600-6143.2011.03656.x","article-title":"Pregnancy outcomes in kidney transplant recipients: A systematic review and meta-analysis","volume":"11","author":"Deshpande","year":"2011","journal-title":"Am. J. Transplant."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1016\/j.mayocp.2018.04.033","article-title":"State-of-the art diagnosis and treatment of hypertension in pregnancy","volume":"93","author":"Magee","year":"2018","journal-title":"Mayo Clin. Proc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1111\/1471-0528.12737","article-title":"Community Level Interventions for Pre-eclampsia (CLIP) Working Group. Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: A systematic review","volume":"121","author":"Firoz","year":"2014","journal-title":"BJOG"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e00644","DOI":"10.1002\/prp2.644","article-title":"Adverse pregnancy outcomes associated with first-trimester exposure to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers: A systematic review and meta-analysis","volume":"8","author":"Buawangpong","year":"2020","journal-title":"Pharmacol. Res. Perspect."},{"key":"ref_39","unstructured":"Fu, J., Tomlinson, G., and Feig, D.S. (2021). Early Pregnancy Exposure to Angiotensin-Converting-Enzyme Inhibitors and Angiotensin Receptor Blockers Associated with Congenital Malformations and Stillbirths: A Systematic Review and Meta-analysis. Diabetes Metab. Res. Rev., online ahead of print."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1111\/aogs.12937","article-title":"Pregnancy outcomes following maternal kidney transplantation: A national cohort study","volume":"95","author":"Majak","year":"2016","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.semnephrol.2010.10.009","article-title":"Pregnancy and kidney transplantation","volume":"31","author":"Josephson","year":"2011","journal-title":"Semin. Nephrol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.2215\/CJN.12081115","article-title":"Preeclampsia updates in pathogenesis, definitions and gudelines","volume":"11","author":"Phipps","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e13297","DOI":"10.1111\/aji.13297","article-title":"Placental extracellular vesicles and pre-eclampsia","volume":"85","author":"Schuster","year":"2021","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.rdc.2017.04.013","article-title":"A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcome","volume":"43","author":"Bandoli","year":"2017","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1016\/j.ajog.2005.02.063","article-title":"Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus","volume":"192","author":"Chakravarty","year":"2005","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Boyd, H.A., Basit, S., Harps\u00f8e, M.C., Wohlfahrt, J., and Jess, T. (2015). Inflammatory Bowel Disease and Risk of Adverse Pregnancy Outcomes. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0129567"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1002\/acr.21807","article-title":"Use of Disease-Modifying Antirheumatic Drugs During Pregnancy and Risk of Preeclampsia","volume":"64","author":"Palmsten","year":"2012","journal-title":"Arthritis Care Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s40264-013-0034-x","article-title":"Ciclosporin use during pregnancy","volume":"36","author":"Paziana","year":"2013","journal-title":"Drug Saf."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1097\/FTD.0000000000000769","article-title":"Usage of Tacrolimus and Mycophenolic Acid During Conception, Pregnancy, and Lactation, and Its Implications for Therapeutic Drug Monitoring: A Systematic Critical Review","volume":"42","author":"Le","year":"2020","journal-title":"Ther. Drug Monit."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/jcpt.13340","article-title":"Pregnancy outcomes in female patients exposed to cyclosporin-based versus tacrolimus-based immunosuppressive regimens after liver\/kidney transplantation: A systematic review and meta-analysis","volume":"46","author":"Gong","year":"2021","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Majak, G.B., Reis\u00e6ter, A.V., Zucknick, M., Lorentzen, B., Vangen, S., Henriksen, T., and Michelsen, T.M. (2017). Preeclampsia in kidney transplanted women; Outcomes and a simple prognostic risk score system. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0173420"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s11906-018-0861-3","article-title":"Preeclampsia risk in kidney donors and recipients","volume":"20","author":"Shah","year":"2018","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/AOG.0000000000002404","article-title":"Preeclampsia and Long-term Renal Function in Women Who Underwent Kidney Transplantation","volume":"131","author":"Vannevel","year":"2018","journal-title":"Obstet Gynecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1056\/NEJM199507273330401","article-title":"A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia","volume":"333","author":"Lucas","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"i5044","DOI":"10.1136\/bmj.i5044","article-title":"Antenatal corticosteroids for maturity of term or nearterm fetuses: A systematic review and meta-analysis of randomized controlled trials","volume":"355","author":"Saccone","year":"2016","journal-title":"BMJ"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.preghy.2018.02.007","article-title":"Thrombotic microangiopathies of pregnancy: Differential diagnosis","volume":"12","author":"Gupta","year":"2018","journal-title":"Pregnancy Hypertens."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1182\/blood.2020005221","article-title":"Management of thrombotic microangiopathy in pregnancy and postpartum: Report from an international working group","volume":"136","author":"Fakhouri","year":"2020","journal-title":"Blood"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1055\/s-0036-1579539","article-title":"Pregnancy-Associated Atypical Hemolytic-Uremic Syndrome","volume":"6","author":"Saad","year":"2016","journal-title":"AJP Rep."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.2215\/CJN.00280117","article-title":"Hemolytic Uremic Syndrome in Pregnancy and Postpartum","volume":"12","author":"Bruel","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1080\/10641955.2020.1801717","article-title":"The role of kidney biopsy in diagnosis of preeclampsia in kidney transplant patients","volume":"39","author":"Dines","year":"2020","journal-title":"Hypertens. Pregnancy"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/ctr.12494","article-title":"The optimal therapy of calcineurin inhibitors for pregnancy in kidney transplantation","volume":"29","author":"Kim","year":"2015","journal-title":"Clin. Transplant."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"481","DOI":"10.2215\/CJN.04800908","article-title":"Calcineurin inhibitor nephrotoxicity","volume":"4","author":"Naesens","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_63","first-page":"8","article-title":"Pregnancy in women with renal disease. Yes or no?","volume":"15","author":"Epidis","year":"2011","journal-title":"Hippokratia"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"HAPO Study Cooperative Research Group, Metzger, B.E., Lowe, L.P., Dyer, A.R., Trimble, E.R., Chaovarindr, U., Coustan, D.R., Hadden, D.R., McCance, D.R., and Hod, M. (2008). Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med., 358, 1991\u20132002.","DOI":"10.1056\/NEJMoa0707943"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2337\/dc11-1790","article-title":"The hyperglycemia and adverse pregnancy outcome study: Associations of GDM and obesity with pregnancy outcomes","volume":"35","author":"Catalano","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.2337\/dc16-1194","article-title":"Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary Analysis of the Hyperglycemia and Adverse Pregnancy Outcome Study","volume":"39","author":"Waters","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"204","DOI":"10.3109\/14767050903550667","article-title":"The hyperglycemia and adverse pregnancy outcome (HAPO) study: Can we use the results as a basis for change?","volume":"23","author":"Coustan","year":"2010","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Lende, M., and Rijhsinghani, A. (2020). Gestational Diabetes: Overview with Emphasis on Medical Management. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17249573"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.ijgo.2005.05.009","article-title":"Pregnancy in patients with previous successful renal transplantation","volume":"90","author":"Yildirim","year":"2005","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/0272-6386(95)90153-1","article-title":"Effect of pregnancy on the long-term function of renal allografts. An update","volume":"26","author":"Sturgiss","year":"1995","journal-title":"Am. J. Kidney Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2732","DOI":"10.1111\/j.1600-6143.2005.01091.x","article-title":"Effect of pregnancy on long-term kidney function in renal transplant recipients treated with cyclosporine and with azathioprine","volume":"5","author":"Fischer","year":"2005","journal-title":"Am. J. Transplant."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/01.tp.0000166912.60006.3d","article-title":"Pregnancy in renal transplant recipients: Long-term effect on patient and graft survival. A single-center experience","volume":"81","author":"Rahamimov","year":"2006","journal-title":"Transplantation"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.ejogrb.2004.11.035","article-title":"Pregnancy outcome after renal allograft transplantation: 15 years\u2019 experience","volume":"121","author":"Ghanem","year":"2005","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1681\/ASN.2008121241","article-title":"Pregnancy and maternal outcomes among kidney transplant recipients","volume":"20","author":"Levidiotis","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1097\/TP.0000000000003026","article-title":"Long-term Graft Survival and Graft Function Following Pregnancy in Kidney Transplant Recipients: A Systematic Review and Meta-analysis","volume":"104","author":"Schellekens","year":"2020","journal-title":"Transplantation"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/qjmed\/hcg142","article-title":"Pregnancy in renal transplant recipients: The Royal Free Hospital experience","volume":"96","author":"Thompson","year":"2003","journal-title":"QJM"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/ctr.12367","article-title":"Predictive factors for adverse pregnancy outcomes after renal transplantation","volume":"28","author":"You","year":"2014","journal-title":"Clin. Transplant."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.kint.2019.03.033","article-title":"A systematic review and meta-analysis indicate long-term risk of chronic and end-stage kidney disease after preeclampsia","volume":"96","author":"Covella","year":"2019","journal-title":"Kidney Int."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"3017","DOI":"10.3389\/fimmu.2019.03017","article-title":"Steroids, pregnancy and fetal development","volume":"10","author":"Solano","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/0002-9378(78)90768-8","article-title":"The transfer and metabolism of corticosteroids in the perfused human placenta","volume":"132","author":"Levitz","year":"1978","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2614","DOI":"10.1210\/endo.132.6.8504762","article-title":"Human placental 11 beta-hydroxysteroid dehydrogenase: Evidence for and partial purification of a distinct NAD-dependent isoform","volume":"132","author":"Brown","year":"1993","journal-title":"Endocrinology"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/bs.ctdb.2016.12.004","article-title":"Mechanisms of glucocorticoid action during development","volume":"125","author":"Busada","year":"2017","journal-title":"Curr. Top. Dev. Biol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.psyneuen.2009.10.003","article-title":"Maternal cortisol and offspring birthweight: Results from a large prospective cohort study","volume":"35","author":"Goedhart","year":"2010","journal-title":"Psychoneuroendocrinology"},{"key":"ref_84","first-page":"485","article-title":"Antenatal dexamethasone and decreased birth weight","volume":"97","author":"Bloom","year":"2001","journal-title":"Obstet. Gynecol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1097\/GRF.0b013e31829939f7","article-title":"Programming effects of glucocorticoids","volume":"56","author":"Reynolds","year":"2013","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/nrendo.2014.73","article-title":"Glucocorticoids and fetal programming part 1: Outcomes","volume":"10","author":"Moisiadis","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/S0039-128X(98)00056-7","article-title":"Placental 11\u03b2-hydroxysteroid dehydrogenase activity in normotensive and pre-eclamptic pregnancies","volume":"63","author":"McCalla","year":"1998","journal-title":"Steroids"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/ar1977","article-title":"Human pregnancy safety for agents used to treat rheumatoid arthritis: Adequacy of available information and strategies for developing post-marketing data","volume":"8","author":"Chambers","year":"2006","journal-title":"Arthritis Res. Ther."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/MJT.0b013e3182491e02","article-title":"Use of corticosteroids in early pregnancy is not associated with risk of oral clefts and other congenital malformations in offspring","volume":"21","author":"Ehrenstein","year":"2014","journal-title":"Am. J. Ther."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1111\/j.1600-6143.2011.03716.x","article-title":"Pregnancy after transplantation. Milestones and assessment of risk","volume":"11","author":"Armenti","year":"2011","journal-title":"Am. J. Transpl."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1097\/00007890-198809000-00032","article-title":"Cyclosporine and its metabolites in mother and baby","volume":"46","author":"Venkataramanan","year":"1988","journal-title":"Transplantation"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1002\/jps.1108","article-title":"Influence of P-glycoprotein on the transplacental passage of cyclosporine","volume":"90","author":"Fendrich","year":"2001","journal-title":"J. Pharm. Sci."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1001\/archinte.160.5.610","article-title":"The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy and lactation","volume":"160","author":"Janssen","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1136\/annrheumdis-2015-208840","article-title":"The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation","volume":"75","author":"Hoeltzenbein","year":"2016","journal-title":"Ann. Rheum. Dis."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1097\/TP.0b013e318278d367","article-title":"Interpreting tacrolimus concentrations during pregnancy and postpartum","volume":"95","author":"Hebert","year":"2013","journal-title":"Transplantation"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1097\/01.tp.0000263357.44975.d0","article-title":"Pregnancy after organ transplantation: A report from the UK Transplant Pregnancy Registry","volume":"83","author":"Sibanda","year":"2007","journal-title":"Transplantation"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1093\/ndt\/gfw232","article-title":"Pregnancy outcomes after kidney graft in Italy: Are the changes over time the result of different therapies or of different policies? A nationwide survey (1978\u20132013)","volume":"31","author":"Piccoli","year":"2016","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.reprotox.2011.08.008","article-title":"The transfer of 6-mercaptopurine in the dually perfused human placenta","volume":"32","author":"Hutson","year":"2011","journal-title":"Reprod. Toxicol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"102925","DOI":"10.1016\/j.autrev.2020.102525","article-title":"In utero exposure to Azathioprine in autoimmune disease. Where do we stand?","volume":"19","author":"Belizna","year":"2020","journal-title":"Autoimmun. Rev."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1586\/1744666X.2014.872562","article-title":"The pros and cons of mTOR inhibitors in kidney transplantation","volume":"10","author":"Ponticelli","year":"2014","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1016\/j.transproceed.2008.06.015","article-title":"Sirolimus used during pregnancy in a living related renal transplant recipient: A case report","volume":"40","author":"Chu","year":"2008","journal-title":"Transpl. Proc."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1097\/TP.0b013e3182154267","article-title":"Successful pregnancy in a living-related kidney transplant recipient who received sirolimus throughout the whole gestation","volume":"91","author":"Corona","year":"2011","journal-title":"Transplantation"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1111\/jog.13369","article-title":"Everolimus in pregnancy: Case report and literature review","volume":"43","author":"Yamamura","year":"2017","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1111\/j.1432-2277.2011.01356.x","article-title":"Pregnancy under everolimus-based immunosuppression","volume":"24","author":"Veroux","year":"2011","journal-title":"Transpl. Int."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.transproceed.2013.09.029","article-title":"Successful maternal and fetal outcome in a kidney transplant patient with everolimus exposure throughout pregnancy: A case report","volume":"46","author":"Margoles","year":"2014","journal-title":"Transpl. Proc."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/0008-8749(90)90182-Q","article-title":"The effects of anti-CD4 and anti-CD8 antibody treatment on placental growth and function in allogeneic and syngeneic murine pregnancy","volume":"129","author":"Athanassakis","year":"1990","journal-title":"Cell. Immunol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1002\/phar.1725","article-title":"Administration of Antithymocyte Globulin (Rabbit) to Treat a Severe, Mixed Rejection Episode in a Pregnant Renal Transplant Recipient","volume":"36","author":"Kutzler","year":"2016","journal-title":"Pharmacotherapy"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1111\/ajt.14911","article-title":"Belatacept during pregnancy in renal transplant recipients: Two case reports","volume":"18","author":"Combs","year":"2018","journal-title":"Am. J. Transpl."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1002\/lt.25785","article-title":"Successful Pregnancy in a Liver Transplant Recipient on Belatacept","volume":"26","author":"Klintmalm","year":"2020","journal-title":"Liver Transpl."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1182\/blood-2010-07-295444","article-title":"Pregnancy outcomes after maternal exposure to rituximab","volume":"117","author":"Chakravarty","year":"2011","journal-title":"Blood"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"e453","DOI":"10.1212\/NXI.0000000000000453","article-title":"Rituximab before and during pregnancy: A systematic review, and a case series in MS and NMOSD","volume":"19","author":"Das","year":"2018","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/nyas.12456","article-title":"Safety issues of biologics in pregnant patients with rheumatic diseases","volume":"1317","author":"Ostensen","year":"2014","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.autrev.2016.07.014","article-title":"Critical review of the current recommendations for the treatment of systemic inflammatory rheumatic diseases during pregnancy and lactation","volume":"15","author":"Levy","year":"2016","journal-title":"Autoimmun. Rev."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.imbio.2014.11.003","article-title":"Eculizumab treatment during pregnancy does not affect the complement system activity of the newborn","volume":"220","author":"Hallstensen","year":"2015","journal-title":"Immunobiology"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1056\/NEJMoa1502950","article-title":"Eculizumab in Pregnant Patients with Paroxysmal Nocturnal Hemoglobinuria","volume":"373","author":"Kelly","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s40620-018-0517-z","article-title":"Eculizumab in pregnancy: A narrative review","volume":"32","author":"Sarno","year":"2019","journal-title":"J. Nephrol."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1002\/ajmg.a.35223","article-title":"Teratogenicity of mycophenolate confirmed in a prospective study of the European Network of Teratology Information Services","volume":"58","author":"Hoeltzenbein","year":"2012","journal-title":"Am. J. Med. Genet. A"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.reprotox.2014.10.015","article-title":"Esophageal atresia and prenatal exposure to mycophenolate","volume":"50","author":"Cristiano","year":"2014","journal-title":"Reprod. Toxicol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1055\/s-0035-1556743","article-title":"Update on the Teratogenicity of Maternal Mycophenolate Mofetil","volume":"4","author":"Coscia","year":"2015","journal-title":"J. Pediatr. Genet."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/S1701-2163(16)34622-9","article-title":"Prenatal exposure to mycophenolate mofetil: An updated estimate","volume":"32","author":"Chitayat","year":"2010","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1055\/s-0036-1597933","article-title":"What is the teratogenic risk of mycophenolate?","volume":"6","author":"Kylat","year":"2017","journal-title":"J. Pediatr. Genet."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/ajt.13928","article-title":"Pregnancy Outcomes Related to Mycophenolate Exposure in Female Kidney Transplant Recipients","volume":"17","author":"King","year":"2017","journal-title":"Am. J. Transpl."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s40620-018-0477-3","article-title":"Immunosuppression in pregnant women with renal disease: Review of the latest evidence in the biologic\u2019s era","volume":"31","author":"Colla","year":"2018","journal-title":"J. Nephrol."},{"key":"ref_124","first-page":"462","article-title":"Teratogenic effects of first-trimester cyclophosphamide therapy","volume":"72","author":"Kirshon","year":"1988","journal-title":"Obstet. Gynecol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1002\/bdra.23004","article-title":"Klippel-Feil syndrome in a boy exposed inadvertently to cyclophosphamide during pregnancy: A case report","volume":"94","year":"2012","journal-title":"Birth Defects Res. A Clin. Mol. Teratol."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.2174\/1871520616666161206150421","article-title":"Congenital Malformations Attributed to Prenatal Exposure to Cyclophosphamide","volume":"17","author":"Rengasamy","year":"2017","journal-title":"Anticancer Agents Med. Chem."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"120","DOI":"10.2215\/CJN.03910319","article-title":"Pregnancy in a kidney transplant patient","volume":"15","author":"Ong","year":"2020","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Gordon, C.E., and Tatsis, V. (2019). Shearing-force injury of a kidney transplant graft during cesarean section: A case report and review of the literature. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1281-6"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/10\/956\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:05:08Z","timestamp":1760166308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/11\/10\/956"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,26]]},"references-count":128,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["jpm11100956"],"URL":"https:\/\/doi.org\/10.3390\/jpm11100956","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,26]]}}}