Key Points

Women with kidney transplantation had higher rates of cesarean sections, deliveries without labor, and vaginal delivery complications.Women with a kidney transplant had more cesarean sections, even after accounting for maternal factors, preterm delivery, and past cesarean sections.Hypertensive disorders of pregnancy and breech presentation were the main drivers of planned cesarean section delivery among transplant recipients.

Background

Factors influencing high cesarean section rates among mothers with a kidney transplant remain unclear.

Methods

Using linked Australia and New Zealand Dialysis and Transplant Registry (1970–2016) and perinatal datasets (1991–2013), we compared deliveries of women with a functioning kidney transplant with those without KRT (non-KRT).

Results

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; P 50% versus 18% non-KRT cohort; P

Conclusions

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.