Pregnancy in women on chronic dialysis in the last decade (2010–2020): a systematic review

Abstract

Background Pregnant women with end-stage renal disease on chronic dialysis are at a high risk of maternal and foetal complications. Over the years, the prognosis of their pregnancies has improved with advances in dialysis treatments and maternal and neonatal care. We conducted this systematic review to examine the recent data on maternal and foetal outcomes in pregnant women with end-stage renal failure on chronic dialysis over the last decade. Methods We made a systematic review of studies on pregnant women on chronic dialysis published between January 1st, 2010, and December 31st, 2020. We searched the following electronic databases: Medline via PubMed, Embase and the Cochrane Library, with search strategies for each database. We checked the titles and abstracts identified by the search equation, and two independent reviewers assessed the articles retrieved. For each study, the two reviewers separately recorded the data from each selected article on a standardised data extraction form. For each article, we recorded relevant general information on the study, patient demographic characteristics, dialysis schedule, pregnancy complications and outcomes, maternal complications, and foetal and neonatal outcomes. Results The literature search yielded 1668 potentially relevant abstracts. After reviewing the titles, abstracts, and full text, we identified 14 studies according to the inclusion criteria. All studies were observational, 9 of them were retrospective and 8 were from the single-centre experience. The total number of women included in these studies was 2364 (range 8 to 2008) and the total number of pregnancies was 2754 (range 8 to 2352). The patients’ ages ranged from 15 to 45 years. Obesity was observed in 808 (34.2%) women and ranged from 1 to 778. Haemodialysis was the predominant modality with 2551 (92.6%) pregnancies and 203 (7.4%) on peritoneal dialysis. Overall, 68 out of 402 (16.9%) spontaneous miscarriages, 21 out of 402 (5.2%) therapeutic abortions and 26 (8.3%) stillbirths among 313 (stillbirths and live births) were recorded. The mean or median gestational age at delivery ranged from 25.2 to 36 weeks. The main maternal complications were preeclampsia 11.9%, hypertension 7.7%, and anaemia 3.9%. Live births represented 287 (71.4%) out of 402 pregnancies, birth weight ranged from 590 g to 3500 g and preterm birth was the main, most common complication in all studies, ranging from 50% to 100%. Intrauterine growth restriction was present in 5.9% and small-for-gestational-age was reported in 18.9% of neonates. There were 22 (7.6%) neonatal deaths among 287 live births and 48 (15.3%) perinatal deaths among 313 total births (stillbirths and live births). Conclusions Presumably, considering the increase in the number of publications and the total number of pregnancies reported therein, the frequency of pregnancy in patients with end-stage chronic kidney disease treated by chronic dialysis has increased. However, the practice of treating pregnant women on dialysis differs significantly among countries. These findings highlight the need to standardise the definition of outcomes and healthcare for pregnant women on dialysis.

Innovative Journeys to Motherhood: Option of Home Dialysis for Women With Advanced Kidney Disease or Kidney Failure

“…Women may face a lack of clinician support and limited or delayed counselling, a narrow window of time for child-bearing, often exacerbated by recommendations to postpone conception until after kidney transplantation, thereby potentially missing their child-bearing years. 1 Navigating these complexities when planning the best timing of a pregnancy involves consideration of CKD progression with pregnancy, risks to mother and baby, clinician experience in managing pregnancies in women with advanced CKD or on dialysis, and capacity to undertake high-risk pregnancy care in a health system under resource pressures. 2 Although fertility is generally low in women with advanced CKD or kidney failure, the initiation of effective dialysis and correction of anemia have the potential to enhance ovulation, increasing the chances of unplanned pregnancies.…”

“…Pregnancies, either planned or unplanned, in women with advanced kidney failure or undergoing dialysis are rare but consistently shown to be increasing. 1 , 4 , 5 In the modern era in high resource settings, live birth rates are much improved; however, these pregnancies remain high-risk for both the mother and baby. 6 Despite these higher risks, growing acceptance of pregnancy on dialysis is propelled by increased experience and advancements in care models.…”

“… 7 Delivering intensive hemodialysis, especially nocturnal or home-based hemodialysis, emerges as a viable option for women with kidney failure aspiring to conceive or achieve healthier pregnancies ( Figure 1 ). Pregnancy in peritoneal dialysis recipients is even more rare, 1 but increasingly recognized as a potential option, especially in early pregnancy. The global surge in initiatives advocating for and facilitating the adoption of home-based dialysis is gaining traction, offering potential advantages for achieving motherhood ( Figure 1 ).…”