Pregnancy and Hemodialysis 25gestational age was 33.2 weeks (range: 25-42 weeks). Two patients suffered
from severe anemia during pregnancy. At that time, anemia was not properly
managed as erythropoietin analogues were not yet developed. Overall, these
results indicated relatively favorable outcomes in some of the women;
however, these patients all had residual renal function, a condition known to
be associated with better fetal outcomes compared with those in patients with
anuria and oliguria.
In 1994, Hou reported on 60 pregnancies from 1,281 women of
childbearing age who were undergoing treatment in dialysis units in the United
States [5]. This report included some pregnancies in patients on continuous
ambulatory peritoneal dialysis. The study showed that 37% of pregnancies
resulted in surviving infants, while 44%, 8%, 3%, and 5% resulted in
spontaneous abortion, elective abortion, stillbirth, and neonatal death,
respectively, while the outcome of pregnancy was not known in 3% of the
pregnancies. This report also showed that only 21% of the pregnancies
resulted in live infants prior to 1990, in contrast to 52% after 1990. During
both time periods, spontaneous abortion was the major cause of pregnancy
loss, accounting for 55% and 35% of terminated pregnancies before and after
1990, respectively. In 1998, Bagon et al. reported successful outcome in 50%
of pregnancies occurring in HD patients [6] and Okundaye et al. reported an
infant survival rate of 40.2% in 184 pregnancies in women who conceived
after starting dialysis (HD or peritoneal dialysis) [7]. In line with these data,
the outcome of successful pregnancy in women on HD between 1990 and
200 2 was 30-60% [5-9]. However, while the outcome of pregnancy improved
during this time period, the above studies found that most deliveries were
premature, at around 29-32 weeks of gestational age, with an average newborn
weight of ≤1600 g, and these results were not satisfactory to ensure healthy
offspring. The neonatal outcomes are significantly worse before 32 weeks of
gestational age; hence, reaching a delivery at over 32 gestational weeks is
important [10].
An effective approach to address these problems involves an increase in
dialysis dose in terms of the frequency per week and duration per session [11].
With the growing popularity of intensive dialysis treatment, the probability of
a healthy offspring was reported in 2010 to range from 50 to 100% as
determined by evaluating 90 pregnancies observed in 78 patients [3].
Moreover, in 2008, Barua et al. [12] reported extremely favorable outcomes of
pregnancies in women on HD with super-high dose dialysis at a mean of 48 ±
5 hours per week during pregnancy, which resulted in a mean pre-dialysis
blood urea level within the normal range. The mean gestational age of the