Pregnancy Outcomes in Egyptian Women on Maintenance Hemodialysis: A Multicenter Observational Study

Abstract

Background and Aims: Women in the childbearing period on hemodialysis (HD) have decreased fertility when compared with the general population. However, pregnancy in this patients’ population is still possible. The aim of the current study was to assess the conception rate in Egyptian HD females.
 Methods: The study comprises 2 phases: phase one studied the frequency of conception in HD females in Egypt, while phase two studied the live birth frequency and factors affecting it in 22 hemodialysis units (HDUs) including 211 females with sexually active partner in their childbearing period comprising 33 females with HD coincidental pregnancies.
 Results: 5-year conception rate was 5.2%, and was associated with higher planned dialysis dose (higher blood flow rate, larger dialyzer size, and session length), better control of blood pressure, as well as a lower level of serum ferritin. Live birth frequency was 33.3% and was statistically significantly associated with younger age of the pregnant lady, higher length of dialysis sessions, lower serum phosphorus level, and suggested better nutrition. There was no maternal mortality associated with HD coincidental pregnancies. There was a better neonatal outcome observed with the caesarian section.
 Conclusion: Fertility is possible and safe in Egyptian HD female with a sexually active partner as there is no maternal mortality but not as such for the fetal outcome. Better conception potentials and the outcome are related to better-planned dialysis dosing and adequate control of phosphate and inflammation.

Efficacy and safety of hemodialysis strategies for pregnant women with chronic kidney disease: Systematic review

“…Four studies 17–21 evaluated neonatal mortality, but only three 17–19 presented the results adequately enough to allow meta‐analysis. Considering the estimated effect observed in the meta‐analysis, the wide CI gives imprecision to the result found, which are compatible with both the increase and the reduction in the risk of neonatal death with the use of any of the hemodialysis strategies (4/45 [8.8%] vs. 11/111 [9.9%]; Peto OR 0.85; 95% CI 0.26–2.80; 3 studies; 156 participants; I 2 = 21%; p = 0.79; very low certainty of evidence) (Figure 2).…”

Amenorrhea, premenstrual tension syndrome, and dysmenorrhea among women of reproductive age on hemodialysis: A national study in Egypt

“…The primary outcome of interest is the percent of women of reproductive age (15–50 years) on hemodialysis with amenorrhea. According to the statistics of the Ministry of Health, the number of these women is about 4,500 13 . A pilot study on 100 women revealed that 30% of these women have amenorrhea, with alpha errors of 5%, precision of 5%, and a design effect of 1.5 due to stratified sampling method.…”

“…According to the statistics of the Ministry of Health, the number of these women is about 4,500. 13 A pilot study on 100 women revealed that 30% of these women have amenorrhea, with alpha errors of 5%, precision of 5%, and a design effect of 1.5 due to stratified sampling method. Thus, the calculated sample size was 452.…”

“…Scarce evidence is available regarding the assessment of reproductive health in women on HD in developing countries including Egypt 13 . The endorsement of this issue seems to be an important step in improving the general health and lifestyle of those patients.…”

“…12 Scarce evidence is available regarding the assessment of reproductive health in women on HD in developing countries including Egypt. 13 The endorsement of this issue seems to be an important step in improving the general health and lifestyle of those patients. This study aimed to estimate the prevalence of amenorrhea, premenstrual tension syndrome and dysmenorrhea, and their associated factors in ESRD women in reproductive age undergoing chronic hemodialysis in Egypt.…”