Endocrinology and Dialysis: Issue and Therapies
Series Editor: Jean L. Holley: Pregnancy in Dialysis Patients: A Review of Outcomes, Complications, and Management

Abstract

Although uncommon, pregnancy occurs in women on chronic dialysis. In 1980 the incidence of pregnancy in women on dialysis was 0.9%. Studies from 1992 to 2003 indicate that pregnancy occurred in 1-7% of women on chronic dialysis. Half of the infants born to women on chronic dialysis survive. Of importance is that "intensive dialysis" of 16-24 hr/week is associated with improved infant survival. In this article, the incidence, duration, fetal and maternal complications, and outcomes of pregnancy in women on chronic dialysis are reviewed. The management of anemia, hypertension, electrolytes, bone minerals, and acid-base parameters in the pregnant dialysis patient is also summarized. Recommendations regarding the dialysis prescription for the pregnant woman on hemodialysis (HD) or peritoneal dialysis (PD) are also made. The complex and precarious condition of the pregnant woman on dialysis requires close collaboration between the patient, nephrologist, dialysis staff, obstetrician, and neonatologist to maximize the chance of a successful pregnancy.

Pregnancy outcomes in women on hemodialysis: a national survey

“…In the 1980s, the incidence of conception on dialysis was ∼0.9% [18]. From 1992 to 2003, the incidence ranged from 1 to 7% [18]. Data from our survey show that US nephrologists are encountering pregnant women on HD more often, with nearly half of responding nephrologists caring for a pregnant woman on HD.…”

“…In the past, the chance of a dialysis patient conceiving was low. In the 1980s, the incidence of conception on dialysis was ∼0.9% [18]. From 1992 to 2003, the incidence ranged from 1 to 7% [18].…”

“…Females on dialysis may lack the estradiol-stimulated luteinizing hormone surge. In addition, prolactin levels may be increased, causing changes that may facilitate anovulatory cycles [18–20]. Additional factors such as decreased libido, body image factors, depression, effect of uremic toxins and pharmacologic side effects from antihypertensive agents or cyclophosphamide may play a role in infertility.…”

Successful multigravid pregnancy in a 42-year-old patient on continuous ambulatory peritoneal dialysis and a review of the literature

“…Pregnant ESRD woman have higher maternal and fetal morbidity and mortalitiy rates as compared to women with normal renal function [10]. The likelihood of an infant surviving in women who conceive after initiation of dialysis is 50%.…”

La grossesse chez les hémodialysées chroniques

“…En raison d'une perturbation de l'axe hypothalamo-hypophysaire, la fertilité est diminuée chez les patientes en HDC qui présentent une diminution de la libido [2], une dysménorrhée et une anovulation dans 50% des cas [3]. Selon la littérature, la fréquence de conception varie selon les pays; de 1,4% par an en Arabie saoudite [4] à 0,5% aux états unis [5] et le taux de réussite varie selon les séries de 30% [6] à 80% [7]. Ces grossesses constituent un groupe à haut risque et n'aboutissent à des nouveau-nés vivants que seulement dans 60% des cas, du fait de la fréquence des complications [8, 9]: la mère est exposée aux accidents hémorragiques dont l'hématome rétro-placentaire (HRP), à une aggravation de l'anémie, à une thrombose de l'abord vasculaire ou du circuit extracorporel et à des anomalies hépatiques dont la cholestase gravidique; le fœtus subit l'anémie maternelle et souffre d'hypoxie chronique; il est menacé d'hydramnios en cas de mauvais contrôle de la volémie; le retard de croissance intra-utérin et la prématurité sont habituels.…”