Pregnancy in Dialysis Patients

Piccoli, Giorgina Barbara; Conijn, A.P.; Consiglio, Valentina; Vasario, Elena; Attini, Rossella; Deagostini, Maria Chiara; Bontempo, Salvatore; Todros, Tullia

doi:10.2215/cjn.05660809

Cited by 112 publications

(102 citation statements)

References 26 publications

(26 reference statements)

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“…Although prematurity is very likely, a large proportion do progress to a satisfactory duration. Other studies from the recent era report a median GA of 31-33 weeks (2,6,9,10,20), with superior GA in patients treated with nocturnal hemodialysis (16,18). Most infants born were of low BW (,2500 g), which correlated with prematurity, although a large proportion of babies were on or below the 10th centile of weight for GA. Our median BW was similar to that in other recent studies, which reported median or mean BW ranging from 1483 to 1765 g (6)(7)(8)(9)(10)20), but it remains substantially less than the mean BW (6 SD) of 2417.56657 g reported in pregnancies managed with nocturnal hemodialysis (16).…”

Section: Discussionmentioning

confidence: 93%

“…However, given prolonged waiting times for organs, this may occur after the reproductive years have passed. With studies such as ours demonstrating improved outcomes for women with CKD who commence dialysis in pregnancy, as well as the growing body of evidence regarding intensive dialysis regimens to improve outcomes (6)(7)(8)(9)(10)16), there may be a shift in the way women are counseled regarding pregnancy on dialysis, toward a less discouraging attitude (2). This may provide an avenue for motherhood in women who otherwise may not have an opportunity.…”

Section: Discussionmentioning

confidence: 97%

“…Factors crucial to successful pregnancy outcome include increased dialysis delivery to optimize biochemical measures, particularly urea (6)(7)(8)(9)(10)(11)(12)16,18), control of hypertension, correction of anemia (7,15), close fetal monitoring (8,10), and a multidisciplinary approach to patient care (2,3,8). An important limitation of ANZDATA data are limited detail regarding such individual patient care, which would assist in further interpreting the differing outcomes observed in our cohort.…”

Section: Discussionmentioning

confidence: 98%

“…Pregnancy in women with advanced CKD or ESRD is a rare, challenging clinical scenario with significant maternal and fetal morbidity (1)(2)(3). Conception rates in women undergoing long-term dialysis have been estimated at 0.3 per 100 patient-years (4,5) or ranging from ,1% to 7% of women (3).…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD

Jesudason

Grace

McDonald

2014

Clinical Journal of the American Society of Nephrology

138

125

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SummaryBackground and objectives Pregnancy in ESRD is rare and poses substantial risk for mother and baby. This study describes a large series of pregnancies in women undergoing long-term dialysis treatment and reviews maternal and fetal outcomes. Specifically, women who had conceived before and after starting long-term dialysis are compared.Design, setting, participants, & measurement All pregnancies reported to the Australian and New Zealand Dialysis and Transplantation Registry from 2001 to 2011 (n=77), following the introduction of specific parenthood data collection, were analyzed.Results Between 2001 and 2011, there were 77 pregnancies among 73 women. Of these, 53 pregnancies were in women who conceived after long-term dialysis was established and 24 pregnancies occurred before dialysis began. The overall live birth rate (after exclusion of elective terminations) was 73%. In pregnancies reaching 20 weeks gestation, the live birth rate was 82%. Women who conceived before dialysis commenced had significantly higher live birth rates (91% versus 63%; P=0.03), but infants had similar birthweight and gestational age. This difference in live birth rate was primarily due to higher rates of early pregnancy loss before 20 weeks in women who conceived after dialysis was established. In pregnancies that reached 20 weeks or more, the live birth rate was higher in women with conception before dialysis commenced (91% versus 76%; P=0.28). Overall, the median gestational age was 33.8 weeks (interquartile range, 30.6-37.6 weeks) and median birthweight was 1750 g (interquartile range, 1130-2417 g). More than 40% of pregnancies reached .34 weeks' gestation; prematurity at ,28 weeks was 11.4% and 28-day neonatal survival rate was 98%.Conclusions Women with kidney disease who start long-term dialysis after conception have superior live birth rates compared with those already established on dialysis at the time of conception, although these pregnancies remain high risk.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD

Jesudason

Grace

McDonald

2014

Clinical Journal of the American Society of Nephrology

138

125

View full text Add to dashboard Cite

show abstract

“…Este fenómeno se acentúa a medida que disminuye la función renal y en pacientes con ERC en etapas 4 y 5, 75% de los RN son pequeños para la edad gestacional y 100% de los partos son prematuros, con un promedio de edad gestacional de 32 semanas, lo cual es bastante similar a nuestros resultados. En la serie de Piccoli, la proteinuria mayor a 1 g/día se correlacionó con el requerimiento de cuidados neonatológicos intensivos y la hipertensión arterial con el parto prematuro 10,11 .…”

Section: Discussionunclassified