Pregnant women during dialysis have significantly worse outcomes compared to women who a) have already received a kidney transplant, or
b) dialysis will finally begin, but it had not yet reached this point at the time of pregnancy, according to data from more than 1.6 million women in Australia and New Zealand.
The new review shows that women on dialysis during pregnancy had the highest pre-existence rates hypertension (42%), cesarean sections (75%), premature births (approximately 85%), babies born less than 2500 g (5.5 lbs; low birth weight) at birth (approximately 77%), ICU admissions neonatal (67%), and neonatal death (11%), and the lowest rate of live births (94.6%) compared with pregnant women in three comparative groups.
The comparisons were:
Women who never needed kidney replacement therapy (TRR, which may include dialysis or transplantation)
Women who started RRT after childbirth and
Women who became pregnant after receiving a kidney transplant
The results “confirm that pregnancy outcomes are worse in women on dialysis [out of these groups], “he said Erandi Hewawasam, doctor, during the 2021 World Congress of Nephrology.
These results “provide a framework for pregnancy counseling. Paternity planning is a key part of kidney care,” said Hewawasam, a researcher in the Australian and New Zealand Dialysis and Transplant Registry ( ANZDATA), a service administered by South Australia Health and the Medical Research Institute in Adelaide.
Pregnancy and neonatal outcomes of women who received the alternative form of RRT, kidney transplantation, were better and approximately similar to the outcomes of pregnant women who would eventually require RRT.
And the pregnancy and newborn outcomes in women in these three groups were worse than women who never needed RRT, the vast majority, more than 99%, of the 1.6 million women in the review. .
Pregnancy in women with kidney disease presents a high risk
“Counseling and awareness are the most important when it comes to pregnancy in women with kidney disease, as it is a high-risk pregnancy and is associated with adverse fetal and maternal outcomes, including a higher risk of cesarean sections, fatalities and neonatal mortality “. he commented Silvi Shah, MD, nephrologist at the University of Cincinnati College of Medicine, Cincinnati, Ohio, specializing in women’s health in kidney disease.
“Women should receive advice on this and should be followed in a tertiary center by a multidisciplinary team that includes a maternal-fetal medicine specialist and a neonatologist,” Shah added.
The new data reported by Hewawasam “confirm previous reports that the risk of adverse pregnancy outcomes increases with worsening kidney function, although pregnancy outcomes in women with kidney transplants are usually better in compared with pregnancy outcomes in women with chronic kidney disease stages 3-5, ”Shah said in an interview.
Progress has been made in preventing fatal fetus in women with kidney disease
Hewawasam and his associates took data from 1.6 million pregnant women and included in prenatal and birth records from four Australian states between 1991-2013 and combined them with ANZDATA figures.
Thus, 761 mothers from the data set who gave birth to their babies before initiating RTR were identified, 137 who became pregnant after receiving a kidney transplant and 31 who were pregnant while on dialysis. The most common cause of kidney disease was glomerulonephritis.
These results are extended in a previous one ANZDATA report in 2013 which included records of 49 pregnancies among women on dialysis between 1966-2008. This study reported a live birth rate of 79% among these women on dialysis, suggesting that progress has been made in preventing mortality in later years.
These women had a rate of 41% premature birth and 39% to have one part by cesarean section. The data set also included 670 women who became pregnant after receiving a kidney transplant and, in contrast to ANZDATA, these women had 18% more births by cesarean section compared to women on hemodialysis. This study did not report neonatal findings.
Hewawasam and Shah have not revealed any relevant financial relationship.
World Congress of Nephrology 2021: Summary LBCT-246. Filed April 7, 2021.