EXPloring Attitudes and Factors Influencing Reproductive Choices in Kidney Transplant Patients (The EXPECT-study)

Pregnancy can have risks after kidney transplantation (KT). This mixed-methods study aimed to identify the percentage of women getting pregnant after KT and explore motives for and against pregnancy together with psychosocial and medical factors involved in decision making. Furthermore, experiences of pregnancy and child-raising were explored. Women who got pregnant after KT were matched with women who had not been pregnant after KT. Semi-structured interviews were conducted, transcribed verbatim and analyzed using directed content analysis. After KT, only 12% of women got pregnant. Eight women with pregnancies after KT were included (P-group) and matched with 12 women who had not been pregnant after KT (NP-group). Women after KT experienced a high threshold to discuss their pregnancy wish with their nephrologist. The nephrologists' advice played an important role in decision-making, but differed between the groups. In the P-group, a desire for autonomy and positive role models were decisive factors in proceeding with their pregnancy wish. In the NP-group, disease burden and risk perception were decisive factors in not proceeding with their pregnancy. Nephrologists need to be proactive in broaching this subject and aware of factors influencing the decision and outcomes. Standardized preconception guidelines on pregnancy counseling are recommended.