Pregnancy and Hemodialysis 29women on HD were estimated to have a 10-fold lower probability of
delivering a live-born baby compared to those who had undergone renal
transplantation [28]. In addition, information regarding renal transplantation
must also be provided to women on HD and their families, including its risks,
locating a potential donor, the use of immunosuppressive medication, and the
requirements in terms of the condition of the mother for the permission of
pregnancy after transplantation, such as the levels of renal function and urine
protein. This information may influence the decision regarding whether to
postpone pregnancy until after a kidney transplantation or not.
Second, pregnancy planning and avoiding delays in the detection of
pregnancy are critical because of the necessary changes in the medical care
and treatment strategy due to pregnancy. In patients on HD, starting an
intensive dialysis treatment as early as possible in pregnancy results in a better
outcome.
However, early detection of pregnancy is likely difficult as patients with
ESRD usually have abnormal hormone function of the ovarian axis, resulting
in a tendency toward irregular menstrual cycles, anovulation, and decreases in
fertility [29-34]. Moreover, a lack of a regular menstrual cycle makes it
difficult to become aware of pregnancy through the cessation of menstrual
periods, and pregnancy tests using serum levels of beta-human chorionic
gonadotropin may not be accurate, as women with ESRD have consistently
increased levels [35]. Therefore, to avoid delays in pregnancy detection in
women on HD, the patient must proactively plan to see an
obstetrician/gynecologist who can diagnose pregnancy using ultrasound.
REFERENCES
[1] Confortini P., Galanti G., Ancona G., Giongo A., Bruschi E., Lorenzini
E., (1971). Full-term pregnancy and successful delivery in a patient on
chronic haemodialysis. Proc. Eur. Dial. Transplant. Assoc., 8, 74-80.
[2] Piccoli G. B., Minelli F., Versino E., Cabiddu G., Attini R., Vigotti F.
N., Rolfo A., Giuffrida D., Colombi N., Pani A., Todros T., (2015).
Pregnancy in dialysis patients in the new millennium: a systematic
review and meta-regression analysis correlating dialysis schedules and
pregnancy outcomes. Nephrol. Dial. Transplant., 27, 1-20.