title: Pregnancy in end stage renal disease.
abstract: The ovulatory menstrual cycle is known to be affected on multiple levels in women with advanced renal disease. Menstrual irregularities, sexual dysfunction, and infertility worsen in parallel with the renal disease. Pregnancy in women with ESRD on dialysis is therefore uncommon. Furthermore, when pregnancy does occur, it can prove hazardous to both mother and baby owing to a multitude of potential complications including accelerated hypertension and preeclampsia, poor fetal growth, anemia, and polyhydramnios. Data are emerging, however, to suggest that pregnancy while on intensified renal replacement regimens may result in better pregnancy outcomes, and emerging trends include the decreased rate of therapeutic abortions probably reflecting a change in counseling practices over time. Nevertheless, a pregnant woman on intensive dialysis requires meticulous follow-up by a dedicated team including nephrology, obstetrics, and a full multidisciplinary staff. In this article, we will address fertility issues in young women with ESRD, review pregnancy outcomes in women on both hemodialysis and peritoneal dialysis, and provide suggestions for the management of the pregnant women on intensive hemodialysis.
authors: Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. michelle.hladunewich@sunnybrook.ca
authors: Michelle
authors: M
authors: Hladunewich
authors: Adam Engel
authors: AE
authors: Hercz
authors: Johannes
authors: J
authors: Keunen
authors: Christopher
authors: C
authors: Chan
authors: Andreas
authors: A
authors: Pierratos
mesh_terms: D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010530:Peritoneal Dialysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D006435:Renal Dialysis