24 Yukari Asamiya, Ken Tsuchiya and Kosaku Nitta
INTRODUCTION
For almost 45 years, there have been case reports on successful outcomes
of pregnancies in women on maintenance hemodialysis (HD) [1]. Initially, this
success was considered to be exceptional, and given the high rate of poor fetal
outcomes, medical opinion was to discourage pregnancy. However, the
frequency of pregnancy in women on HD has increased worldwide.
Accumulating reports concerning the challenged experiences of pregnancy in
women on HD have provided some key information regarding ways to
improve fetal outcome and reduce maternal complications. The most effective
management contributing to successful outcomes has been proven to be
increased dialysis dose [2]. Although still uncommon, and carrying a certain
degree of risk to pregnancy, the current medical opinion regarding pregnancy
in women on HD has recently changed from ‘impossible’ to ‘possible’ and
pregnancy should not be automatically discouraged [3]. Therefore, it is
imperative to provide sufficient informed consent to patients and their family
members before pregnancy. Herein, we present a review, based on published
reports, of the major key points regarding the history, change in outcomes,
current management recommendations, and the necessary information that
should be provided to women on HD, and their families.
PREGNANCY OUTCOMES ASSOCIATED WITH INTENSIVE
DIALYSIS TREATMENT
The initial report of a successful pregnancy and delivery in a patient
undergoing chronic HD was published in 1971 [1]. This case was considered
to be an extremely exceptional occurrence. In 1980, the registration committee
of the European Dialysis Transplant Association reported 16 successful
pregnancies occurring in women on dialysis, all of whom had some residual
renal function, as evidenced by a mean urine volume of 800 ml/day (range:
200 - 1600 ml/day) [4]. Four of the 16 babies born to these women on dialysis
were conceived before dialysis was commenced; the periods of dialysis before
delivery were 4, 10, 10, and 19 weeks. The remaining 12 pregnancies were
completed after a mean of 2.2 years of dialysis. During the pregnancies, the
mean dialysis time was 18 hours per week (range: 7 to 27 hours) and mean
frequency of dialysis was 3 times per week (range: 2 to 6). In the total 16
newborns, the mean birth weight was 1.9 kg (range: 0.8-2.5 kg) and the mean