title: Children of a lesser god or miracles? An emotional and behavioural profile of children born to mothers on dialysis in Italy: a multicentre nationwide study 2000-12.
abstract: BACKGROUND
  Pregnancy on dialysis is increasingly being reported. This study evaluates the behavioural profile of the children of mothers on dialysis and the parental stress their mothers undergo when compared with a group of mothers affected by a different chronic disease (microcythaemia) and a group of healthy control mothers.
  
  
  METHODS
  Between 2000 and 2012, 23 on-dialysis mothers gave birth to 24 live-born children in Italy (23 pregnancies, 1 twin pregnancy, one of the twins deceased soon after delivery); of these, 16 mothers and 1 father (whose wife died before the inquiry) were included in the study (1 mother had died and the father was unavailable; 2 were not asked to participate because their children had died and 3 were unavailable; children: median age: 8.5, min-max: 2-13 years). Twenty-three mothers affected by transfusion-dependent microcythaemia or drepanocitosis (31 pregnancies, 32 children) and 35 healthy mothers (35 pregnancies, 35 children; median age of the children: 7, min-max: 1-13 years) were recruited as controls. All filled in the validated questionnaires: 'Child Behaviour Checklist' (CBCL) and the 'Parental Stress Index-Short Form' (PSI-SF).
  
  
  RESULTS
  The results of the CBCL questionnaire were similar for mothers on dialysis and healthy controls except for pervasive developmental problems, which were significantly higher in the dialysis group, while microcythaemia mothers reported higher emotional and behavioural problems in their children in 8 CBCL sub-scales. Two/16 children in the dialysis and 3/32 in the microcythaemia group had pathological profiles, as assessed by T-scores (p: ns). PSI-SF indicated a normal degree of parental stress in microcythaemia subjects and healthy controls, while mothers on dialysis declared significantly lower stress, suggesting a defensive response in order to minimize problems, stress or negativity in their relationship with their child.
  
  
  CONCLUSIONS
  According to the present analysis, the emotional and behavioural outcome is normal in most of the children from on-dialysis mothers. A 'positive defence' in the dialysis mothers should be kept in mind when tailoring psychological support for this medical miracle.
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, ASOU san Luigi, University of Turin, Turin, Italy.
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.affiliation: Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Postorino
authors.affiliation: SC Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy.
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Cabiddu
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, ASOU san Luigi, University of Turin, Turin, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Ghiotto
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, ASOU san Luigi, University of Turin, Turin, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Guzzo
authors.affiliation: SCDU Microcythemia, Department of Oncology, ASOU san Luigi, University of Turin, Turin, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Roggero
authors.affiliation: SC Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Manca
authors.affiliation: 2nd Pediatric Clinic, University of Cagliari, Cagliari, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Puddu
authors.affiliation: 2nd Pediatric Clinic, University of Cagliari, Cagliari, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Meloni
authors.affiliation: Obstetrics, Department of Oncology, University of Turin, Turin, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.affiliation: 2nd Pediatric Clinic, University of Cagliari, Cagliari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Moi
authors.affiliation: Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Bruna
authors.initials: B
authors.lastname: Guida
authors.affiliation: SC Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maxia
authors.affiliation: SCDU Microcythemia, Department of Oncology, ASOU san Luigi, University of Turin, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Piga
authors.affiliation: Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mazzone
authors.affiliation: SC Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.affiliation: SCDU Nephrology, Reggio Calabria Hospital, Reggio Calabria, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Postorino
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002675:Child, Preschool; D003376:Counseling; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000209:etiology; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D006435:Renal Dialysis / Q000009:adverse effects*; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology; D011795:Surveys and Questionnaires
keywords: ESRD; depression; dialysis; microcythaemia; pregnancy; stress