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Growth Disorders --- Growth --- Child --- Adolescent --- Growth disorders --- Children --- Teenagers

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Between 1976 and 1994, fifty babies of female kidney transplant recipient were born at Saint-Luc Hospital. The incidence of the intrauterine growth retardation was our main interest. This study assessed the effects of mother’s health and immunosuppressive therapy on fetal growth. The data were collected from the following sources :
- review of clinical records ;
- a previous study carried out in nephrology department.
12% of the newborns suffer from a intrauterine growth retardation. An increase of arterial pressure or serum creatinine level goes together with a decrease of fetal growth. A higher serum creatinine level or one equal to 2 mg/dl increases risk of fetal hypotrophy. There is a relationship between birthweight, gestational age and the delay between transplantation and pregnancy. However, this is probably to be explained by the increase of the serum creatinine level according to the age of the graft. As far as immunosuppressive drugs are concerned, only azathioprine seems to interfere with fetal growth, particularly with the growth of head circumference. Prednisolone could indirectly alter fetal growth by pushing up the arterial pressure. The introduction of cyclosporine in the immunosuppressive therapy leads to diminution of azathioprine dose without noting a perceptible modification of the complication rate. The antihypertensive therapy could also alter fetal growth. The intrauterine growth retardation could find its origin in a placental insufficiency. The maternal risk factors (high arterial pressure, renal dysfunction) have probably effects on the placental exchanges between the mother and her baby.
There is also a high incidence of prematurity (32%) that explains most neonatal complications. Nevertheless, we are surprised to notice four cardiac malformations.
According to the gathered information, these children develop well and lead a normal life including education Entre 1976 et 1994, 50 nouveau-nés de mère greffée du rein sont nés aux Cliniques Universitaires St-Luc. Sur base des dossiers médicaux et des résultats d’une étude antérieure réalisée dans le service de néphrologie, nous nous sommes essentiellement intéressé à l’importance du retard de croissance intra-utérin dans cet échantillon. Nous avons évalué l’impact de la santé maternelle et du traitement immunosuppresseur sur la croissance fœtale.
12% de ces enfants présentent un retard de croissance intra-utérin. Le développement fœtal est amoindri lorsque la tension artérielle ou la créatininémie de la maman s’élèvent. Une créatininémie supérieure ou égale à 2 mg/dl augmente le risque d’hypotrophie fœtale. Le délai entre la transplantation et la grossesse est en relation avec le poids de naissance et l’âge gestationnel mais ce résultat est sans doute le fait d’une augmentation de la créatininémie en fonction de l’âge de la greffe. En ce qui concerne le traitement immunosuppresseur, seule la dose d’azathioprine semble jouer un rôle dans la croissance, et plus particulièrement celle du périmètre crânien. La prednosolone, quant à elle, pourrait intervenir indirectement en induisant une élévation de la tension artérielle. L’introduction de la ciclosporine dans le traitement immunosuppresseur a eu pour conséquence de diminuer la dose d’azathioprine sas pour autant noter une modification sensible du taux de complication. Les antihypertenseurs administrés à 47% des mamans pourraient également toucher la croissance fœtale. Nous suspectons que le retard de croissance intra-utérin trouve son origine dans une insuffisance placentaire. Les facteurs de risque maternels (une tension artérielle élevée, un dysfonctionnement rénal) ont probablement des répercussions sur les échanges placentaires existant entre la mère et son bébé.
Ces enfants présentent aussi un taux de prématuré élevé (32%) qui explique en partie les complications néonatales. Nous sommes étonnés d’observer 4 malformations cardiaques.
D’après les renseignements que nous avons récoltés, ces enfants se développement bien et mènent une vie et une scolarisation normale

Fetus --- Growth Disorders --- Kidney Transplantation --- Fetal Growth Retardation

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Human genetics --- Human embryology --- Paediatrics --- Congenital Abnormalities --- Abnormalities, Human --- Genetic disorders --- Morphogenesis --- Birth injuries --- Growth disorders --- Etiology --- Congenital Abnormalities. --- -Birth injuries --- 605.2 --- pediatrie --- Morphogeny --- Organogenesis --- Embryology --- Morphology --- Metabolism --- Congenital diseases --- Disorders, Genetic --- Disorders, Inherited --- Genetic diseases --- Hereditary diseases --- Inherited diseases --- Diseases --- Medical genetics --- Injuries, Birth --- Newborn infants --- Labor (Obstetrics) --- Abnormalities --- Anomalies, Congenital --- Birth defects --- Congenital abnormalities --- Congenital anomalies --- Defects, Birth --- Deformities --- Developmental abnormalities --- Human abnormalities --- Malformations, Congenital --- Pathology --- Teratogenesis --- Teratology --- Abnormalities, Congenital --- Defects, Congenital --- Birth Defects --- Congenital Defects --- Abnormality, Congenital --- Birth Defect --- Congenital Abnormality --- Congenital Defect --- Defect, Birth --- Defect, Congenital --- Deformity --- Fetal Diseases --- Infant, Newborn, Diseases --- Kindergeneeskunde - Pediatrie --- Disorders --- Wounds and injuries --- Complications --- Birth injuries. --- Genetic disorders. --- Growth disorders. --- Morphogenesis. --- Abnormalities. --- Etiology. --- Fetal Anomalies --- Fetal Malformations --- Anomaly, Fetal --- Fetal Anomaly --- Fetal Malformation --- Malformation, Fetal --- Abnormalities, Human - Etiology