Contraceptive use among women with kidney transplants in the United States

Women who receive a kidney transplant have low rates of contraceptive use according to new research from the University of Cincinnati. The study, published in the Journal of Nephrology, finds an overall contraceptive use rate of 9.5% among women with kidney transplant in the United States.

“Although kidney failure adversely impacts fertility, there is a return of reproductive function following a kidney transplant, and conception is common. History of kidney transplant increases the risk of adverse pregnancy outcomes, including pre-eclampsia, gestational hypertension, low birth weight babies, and preterm births,” says Silvi Shah, MD, associate professor in the Division of Nephrology, Kidney CARE Program in the University of Cincinnati College of Medicine and lead author of the study. “Unplanned pregnancies occur in women with kidney transplant. It is of paramount importance that pregnancies in this high-risk population are planned and underlines the importance of counseling women about family planning and the impact of pregnancy on kidney transplant, and the impact of kidney transplant on maternal and fetal outcomes.”

The study evaluated 13,150 women of childbearing age for each calendar year women with kidney transplantation between 1/1/2005 and 12/31/2013, who were aged 15–44 years with Medicare as the primary payer and linked data from the United Network for Organ Sharing, for up to three entire years after the date of transplantation. Overall, the rate of contraceptive use was 9.5%. The mean age at study entry was 29±7 years for women with any contraceptive use. The contraceptive use was highest among women aged 15-24 years (14.6%) and lowest among women aged 40-44 years (4.1%). The study showed that younger age, Native American and black race/ethnicity, and glomerular filtration rate < 60 ml/min/1.73 m² were associated with a higher likelihood of contraceptive use and second- and third-year post-transplant were associated with a lower likelihood of contraceptive use. Interestingly, the socioeconomic status and donor type did not impact the likelihood of contraceptive use.

Shah says the study unique is that it addresses a comprehensive group of all women with history of kidney transplants of all racial and ethnic groups in the United States to better understand the incidence of contraceptive use and factors associated with it. The study further took into account patients with complete Medicare coverage, thus avoiding the potential shortfalls of registries dependent on voluntary reporting or patient recall. This study shows for the first time that contraceptive rates in women with kidney transplant remain low in the United States.  

“We were not able to account for use of natural methods or use of condoms by men in our study, which remains a limitation. However, our results highlight that contraceptive use among women with kidney transplants is low,” says Shah. “The low rate of contraceptive use among women with kidney transplants may be attributed to lack of awareness about return of fertility and inadequate counseling regarding contraception to prevent unplanned pregnancies. Therefore, we need to include contraceptive counselling for women with kidney transplants in routine clinical care. Additionally, the present study emphasizes the importance of formulating policies that promote awareness of reproductive health and contraception among women with kidney transplants.”

Assisting her in the research were Annette Christianson, research associate in the University of Cincinnati Department of Environmental Health, Shalini Bumb, MD, in the University of Cincinnati Division of Nephrology Kidney/CARE Program and Prasoon Verma, MD, in the University of Cincinnati Department of Pediatrics. Shah is supported by the National Institutes of Health K23 career development award, under award number 1K23HL151816-01A1 and the intramural funds.