28 Yukari Asamiya, Ken Tsuchiya and Kosaku Nitta
the popularization of intensive dialysis treatment, the proportion of pregnant
women on HD with deliveries in the “late preterm period” increased,
indicating that most infants were born healthy [12, 13].
Lastly, polyhydramnios is a common complication, with a rate of 30-70%
in pregnant women on HD [9, 11, 16, 17, 19]. On the other hand, the risk for
maternal death is considered very low [20], although a few cases were
reported in 1998 [7]. In addition, the rate of malformations in infants born
from patients on HD is considered similar to the risk in the overall population
[3].
ANEMIA, NUTRITION AND MINERAL ADJUSTMENT
Treatment of anemia during pregnancy is critical. Previous studies,
including a meta-analysis, have shown that the rate of preterm delivery
increased in women with moderate to severe anemia [26, 27]. In patients on
HD, our group also showed that the average hemoglobin level was
significantly higher in women with successful pregnancies compared with that
in women with unsuccessful pregnancies [16]. In line with these data, the
third-trimester hematocrit has been observed to be positively related to birth
weight and to be associated with a lower risk of adverse fetal outcomes [17].
Management of nutrition and mineral adjustment are also important. Nutrition
management during pregnancy is important, because patients on HD are likely
to have deficits of nutrients such as folate and iron [14]. Administration of
vitamin D and calcium is recommended [14]. Furthermore, as intensive
dialysis with regular dialysate is likely to cause hypokalemia, attention to
serum potassium level is required.
INFORMED CONSENT AND COUNSELING
BEFORE PREGNANCY
Prior to pregnancy, medical doctors and staff must provide certain
information to women on HD and their family members. First, the chances of
conception and pregnancy outcomes, including the rate of live births, long-
term infant outcomes, and risk to both the mother and fetus, are known to be
significantly better in patients after a successful renal transplantation
compared with those in patients on HD. For example, one report stated that