Obstetric outcome in pregnant women on long-term dialysis: a case series.
BACKGROUND
Although still uncommon, pregnancy frequency in women on maintenance hemodialysis therapy has increased in the past 20 years. Most published reports suggest that intensified hemodialysis regimens result in better pregnancy outcomes. The small number of patients investigated in all reported series is the main limitation of the available studies.


METHODS
Retrospective case series.


METHODS
Data for all pregnancies that occurred in 1988-2008 in women undergoing maintenance hemodialysis (52 pregnancies) at the São Paulo University Medical School (São Paulo, Brazil).


METHODS
We analyzed maternal and fetal outcomes of 52 pregnancies, as well as their relationship with various clinical, laboratory, and hemodialysis parameters, such as pre-eclampsia, pregnancy before or after dialysis therapy, hemodialysis dose, polyhydramnios, anemia, and predialysis serum urea level. In addition, logistic regression models for a composite adverse fetal outcome (perinatal death or extremely premature delivery) and linear regression models for birth weight were built.


RESULTS
87% overall rate of successful delivery, with a mean gestational age of 32.7 +/- 3.1 weeks. Pre-eclampsia was associated with a poor prognosis compared with pregnancies without pre-eclampsia: a successful delivery rate of 60% versus 92.9% (P = 0.02), extremely premature delivery rate of 77.8% versus 3.3% (P < 0.001), lower gestational age (P < 0.001), and birth weight (P < 0.001). Patients with an adverse composite fetal outcome had a higher frequency of pre-eclampsia (P < 0.001), lower frequency of polyhydramnios (P = 0.03), lower third-trimester hematocrit (P = 0.03), and higher predialysis serum urea level (P = 0.03). The same results were seen for birth weight.


CONCLUSIONS
Retrospective data analysis. The absence of creatinine clearance measurements did not allow evaluation of the impact of residual renal function on fetal outcome.


CONCLUSIONS
Outcomes of pregnancy in women undergoing hemodialysis often are good. Pre-eclampsia, third-trimester hematocrit, polyhydramnios, and predialysis serum urea level are important variables associated with fetal outcome and birth weight.
Luders
Claudio
C
Department of Internal Medicine, Division of Nephrology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Castro
Manuel Carlos Martins
MC
Titan
Silvia Maria
SM
De Castro
Isac
I
Elias
Rosilene Mota
RM
Abensur
Hugo
H
Romão
João Egidio
JE
D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D011225:Pre-Eclampsia / Q000097:blood / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000628:therapy*; D011256:Pregnancy Outcome; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult