Pregnancy in patients on chronic dialysis: a single center experience and combined analysis of reported results.
OBJECTIVE
Pregnancy is rare in patients on chronic dialysis, with only a 30-50% rate of successful delivery reported in a previous review article. The pregnancy outcome has improved in recent decades, but data on pregnancy outcome are limited due to the small sample size of previous case series. This study investigated the pregnancy outcome in patients on chronic dialysis over the past 15 years in a single center, and also performed a combined analysis of results of individual cases from previously reported series to obtain overall estimates of rates of successful delivery.


METHODS
Medical records for a total of 13 pregnancies in 13 women undergoing chronic dialysis (10 on hemodialysis and 3 on peritoneal dialysis) during the period from 1990 to 2006 in our hospital were retrospectively reviewed. Data on the changes in dialysis regimen, medical complications, obstetric conditions, and perinatal problems were collected. An electronic search of PubMed identified 10 case series studies and 12 case reports published after 1990 with adequate individual information available. Pooled data from a total of 131 cases, including our patients (117 hemodialysis and 14 peritoneal dialysis), were analyzed using the chi(2)-test and the t-test to compare the rate of successful delivery and birth weight in the hemodialysis group and the peritoneal dialysis group, and in pregnancies with conception prior to and those with conception after starting dialysis.


RESULTS
Among the 10 pregnant women who decided to continue their pregnancies in our hospital, 5 delivered live newborns and 5 pregnancies ended with intra-uterine fetal demise or neonatal death. The overall rate of successful delivery was 70.9% (83 out of 117) in patients on hemodialysis and 64.2% (9/14) in patients on peritoneal dialysis. The birth weight for these groups was 1483+/-116 and 1623+/-320 g, respectively. The difference in the rates of successful delivery in these two groups was not significant (p=0.61). However, the birth weight was significantly greater in patients who conceived after than those who conceived prior to starting hemodialysis (1529+/-132 g versus 1245+/-200 g; p=0.04).


CONCLUSIONS
This study found that the outcome of pregnancy on chronic dialysis has improved in recent decades, but our study showed no significant difference in the rate of successful delivery between patients on hemodialysis and those on peritoneal dialysis.
Chou
Ching-Yu
CY
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
Ting
I-Wen
IW
Lin
Tzu-Hung
TH
Lee
Chien-Nan
CN
D000328:Adult; D001724:Birth Weight / Q000502:physiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology* / Q000628:therapy; D011256:Pregnancy Outcome; D006435:Renal Dialysis; D013997:Time Factors