Pregnancy in dialysis patients: is the evidence strong enough to lead us to change our counseling policy?
OBJECTIVE
Although successful pregnancy is rare, results attained with higher dialysis efficiency and the spread of dialysis to different cultural and religious settings are changing the panorama. In this study, we systematically review the recent literature (2000 through 2008) on pregnancy in dialysis.


METHODS
Medline on OVID was searched in November 2008, with MESH and free terms on pregnancy and chronic kidney disease or dialysis; limits were human subjects and English-language articles. Case reports were excluded to minimize publication bias. The final selection and extraction of data were performed in duplicate.


RESULTS
From 2840 references, 241 full-text articles were retrieved; eight fulfilled the selection criteria, and two were added from reference lists. In the 10 studies (nine of 10 monocentric), 90 pregnancies were observed in 78 patients (range of cases five to 15). The studies were heterogeneous for definition of outcomes, duration (2 to 16 yr), period (1988 through 1998 to 2000 through 2006), age (25 to 35 yr), and support and dialysis therapy. Daily dialysis was frequently used; type of treatment, membranes, and flows varied widely. Hypertension and anemia were frequent concerns for the mothers. Intrauterine deaths, hydramnios, and small-for-gestational-age or preterm infants were frequent. The possibility of a healthy offspring ranged from 50 to 100% (overall 76.25%).


CONCLUSIONS
Evidence on pregnancy in dialysis is heterogeneous; however, the growing number of reports worldwide and the improving results suggest that we should reconsider our counseling policy, which only rarely includes pregnancy in dialysis patients.
Piccoli
Giorgina Barbara
GB
Unit of Nephrology, Department of Clinical and Biological Sciences, University of san Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy. gbpiccoli@yahoo.it
Conijn
Anne
A
Consiglio
Valentina
V
Vasario
Elena
E
Attini
Rossella
R
Deagostini
Maria Chiara
MC
Bontempo
Salvatore
S
Todros
Tullia
T
D037001:Directive Counseling; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D006435:Renal Dialysis