Abstract
Pregnancy is uncommon in women with end-stage renal disease (ESRD). Fertility rates are low in women on dialysis, and physicians still frequently counsel women with ESRD against pregnancy. Advancements in the delivery of dialysis and obstetric care have led to improved live birth rates in women on dialysis, so pregnancy for young women with ESRD is now more feasible and safer. However, these pregnancies remain high-risk for both maternal and fetal complications, necessitating experienced multidisciplinary care. In this article, we review fertility issues in women with ESRD, discuss pregnancy outcomes in women on dialysis, and provide an approach for management of pregnant women with ESRD.
References
1.
Holley JL, Schmidt RJ, Bender FH, Dumler F, Schiff M: Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis 1997; 29: 685–690.
2.
Lin CT, Liu XN, Xu HL, Sui HY: Menstrual disturbances in premenopausal women with end-stage renal disease: a cross-sectional study. Med Princ Pract 2016; 25: 260–265.
3.
Mantouvalos H, Metallinos C, Makrygiannakis A, Gouskos A: Sex hormones in women on hemodialysis. Int J Gynecol Obstet 1984; 22: 367–370.
4.
Matuszkiewicz-Rowinska J, Skorzewska K, Radowicki S, Niemczyk S, Sokalski A, Przedlacki J, Puka J, Switalski M, Wardyn K, Grochowski J, Ostrowski K: Endometrial morphology and pituitary-gonadal axis dysfunction in women of reproductive age undergoing chronic haemodialysis – a multicentre study. Nephrol Dial Transplant 2004; 19: 2074–2077.
5.
Gomez F, de la Cueva R, Wauters JP, Lemarchand-Beraud T: Endocrine abnormalities in patients undergoing long-term hemodialysis. The role of prolactin. Am J Med 1980; 68: 522–530.
6.
Strippoli GF; Collaborative Depression and Sexual Dysfunction (CDS) in Hemodialysis Working Group, Vecchio M, Palmer S, et al: Sexual dysfunction in women with ESRD requiring hemodialysis. Clin J Am Soc Nephrol 2012; 7: 974–981.
7.
Öyekçin DG, Gülpek D, Sahin EM, Mete L: Depression, anxiety, body image, sexual functioning, and dyadic adjustment associated with dialysis type in chronic renal failure. Int J Psychiatry Med 2012; 43: 227–241.
8.
Wang GC, Zheng JH, Xu LG, Min ZL, Zhu YH, Qi J, Duan QL: Measurements of serum pituitary-gonadal hormones and investigation of sexual and reproductive functions in kidney transplant recipients. Int J Nephrol 2010; 2010: 1–6.
9.
Pertuz W, Castaneda DA, Rincon O, Lozano E: Sexual dysfunction in patients with chronic renal disease: does it improve with renal transplantation? Transplant Proc 2014; 46: 3021–3026.
10.
van Eps C, Hawley C, Jeffries J, Johnson DW, Campbell S, Isbel N, Mudge DW, Prins J: Changes in serum prolactin, sex hormones and thyroid function with alternate nightly nocturnal home haemodialysis. Nephrology (Carlton, Vic) 2012; 17: 42–47.
11.
Shahir AK, Briggs N, Katsoulis J, Levidiotis V: An observational outcomes study from 1966–2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology 2013; 18: 276–284.
12.
Piccoli GB, Minelli F, Versino E, Cabiddu G, Attini R, Vigotti FN, Rolfo A, Giuffrida D, Colombi N, Pani A, Todros T: Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrol Dial Transplant 2016; 31: 1915–1934
13.
Piccoli GB, Conijn A, Consiglio V, Vasario E, Attini R, Deagostini MC, Bontempo S, Todros T: Pregnancy in dialysis patients: is the evidence strong enough to lead us to change our counseling policy? Clin J Am Soc Nephrol 2010; 5: 62–71.
14.
Barua M, Hladunewich M, Keunen J, Pierratos A, McFarlane P, Sood M, Chan CT: Successful pregnancies on nocturnal home hemodialysis. Clin J Am Soc Nephrol 2008; 3: 392–396.
15.
Okundaye I, Abrinko P, Hou S: Registry of pregnancy in dialysis patients. Am J Kidney Dis 1998; 31: 766–773.
16.
Hou S: Pregnancy in women treated with dialysis: lessons from a large series over 20 years. Am J Kidney Dis 2010; 56: 5–6.
17.
Hou SH: Frequency and outcome of pregnancy in women on dialysis. Am J Kid Dis 1994; 23: 60–63.
18.
Asamiya Y, Otsubo S, Matsuda Y, Kimata N, Kikuchi K, Miwa N, Uchida K, Mineshima M, Mitani M, Ohta H, Nitta K, Akiba T: The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int 2009; 75: 1217–1222.
19.
Haase M, Morgera S, Bamberg C, Halle H, Martini S, Hocher B, Diekmann F, Dragun D, Peters H, Neumayer HH, Budde K: A systematic approach to managing pregnant dialysis patients – the importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant 2005; 20: 2537–2542.
20.
Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M, Tennankore K, Keunen J, Hui D, Chan CT: Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol 2014; 25: 1103–1109.
21.
Jesudason S, Grace BS, McDonald SP: Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD. Clin J Am Soc Nephrol 2013; 9: 143–149.
22.
Successful pregnancies in women treated by dialysis and kidney transplantation: report from the Registration Committee of the European Dialysis and Transplant Association. Br J Obstet Gynaecol 1980; 87: 839–845.
23.
Luders C, Martins Castro MC, Titan SM, De Castro I, Elias RM, Abensur H, Romão JE: Obstetric outcome in pregnant women on long-term dialysis: a case series. Am J Kidney Dis 2010; 56: 77–85.
24.
Kioko EM, Shaw KM, Clarke AD, Warren DJ: Successful pregnancy in a diabetic patient treated with continuous ambulatory peritoneal dialysis. Diabetes Care 1983; 6: 298–300.
25.
Jakobi P, Ohel G, Szylman P, Levit A, Lewin M, Paldi E: Continuous ambulatory peritoneal dialysis as the primary approach in the management of severe renal insufficiency in pregnancy. Obstet Gynecol 1992; 79: 808–810.
26.
Batarse RR, Steiger RM, Guest S: Peritoneal dialysis prescription during the third trimester of pregnancy. Perit Dial Int 2015; 35: 128–134.
27.
Jefferys A, Wyburn K, Chow J, Cleland B, Hennessy A: Peritoneal dialysis in pregnancy: a case series. Nephrology 2008; 13: 380–383.
28.
Bennett-Jones DN, Aber GM, Baker K: Successful pregnancy in a patient treated with continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 1989; 4: 583–585.
29.
Lew SQ, Watson JA: Urea and creatinine generation and removal in a pregnant patient receiving peritoneal dialysis. Adv Perit Dial 1992; 8: 131–135.
30.
Lew SQ: Persistent hemoperitoneum in a pregnant patient receiving peritoneal dialysis. Perit Dial Int 2006; 26: 108–110.
31.
Gadallah MF, Ahmad B, Karubian F, Campese VM: Pregnancy in patients on chronic ambulatory peritoneal dialysis. Am J Kid Dis 1992; 20: 407–410.
32.
Tison A, Lozowy C, Benjamin A, Usher R, Prichard S: Successful pregnancy complicated by peritonitis in a 35- year old CAPD patient. Perit Dial Int 1996; 16(suppl 1):S489–S491.
33.
Walfisch A, Al-maawali A, Moretti ME, Nickel C, Koren G: Teratogenicity of angiotensin converting enzyme inhibitors or receptor blockers. J Obstet Gynaecol 2011; 31: 465–472.
34.
Wehmann RE, Amr S, Rosa C, Nisula BC: Metabolism, distribution and excretion of purified human chorionic gonadotropin and its subunits in man. Ann Endocrinol (Paris) 1984; 45: 291–295.
35.
Coskun A, Bicik Z, Duran S, Alcelik A, Soypacaci Z, Yavuz O, Oksuz S: Pregnancy-associated plasma protein A in dialysis patients. Clin Chem Lab Med 2007; 45: 63–66.
36.
Wittfooth S, Tertti R, Lepäntalo M, Porela P, Qin Q-P, Tynjälä J, Inkinen O, Perttilä J, Airaksinen KE, Pettersson K: Studies on the effects of heparin products on pregnancy-associated plasma protein A. Clinica Chimica Acta 2011; 412: 376–381.
37.
Gomes S, Lopes C, Pinto E: Folate and folic acid in the periconceptional period: recommendations from official health organizations in thirty-six countries worldwide and WHO. Public Health Nutr 2016; 19: 176–189.
38.
Roberge S, Villa P, Nicolaides K, Giguère Y, Vainio M, Bakthi A, Ebrashy A, Bujold E: Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diag Ther 2012; 31: 141–146.
39.
Alp Ikizler T, Flakoll PJ, Parker RA, Hakim RM: Amino acid and albumin losses during hemodialysis. Kidney Int 1994; 46: 830–837.
40.
Reisenberger K: Transfer of erythropoietin across the placenta perfused In vitro. Obstet Gynecol 1997; 89: 738–742.
41.
American College of Obstetricians and Gynecologists; Gynecologists, Task Force on Hypertension in Pregnancy: Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122: 1122–1131.
42.
Piccoli GB, Gaglioti P, Attini R, Parisi S, Bossotti C, Olearo E, Oberto M, Ferraresi M, Rolfo A, Versino E, Biolcati M, Todros T: Pre-eclampsia or chronic kidney disease? The flow hypothesis. Nephrol Dial Transplant 2013; 28: 1199–1206.
43.
Shan HY, Rana S, Epstein FH, Stillman IE, Karumanchi SA, Williams ME: Use of circulating antiangiogenic factors to differentiate other hypertensive disorders from preeclampsia in a pregnant woman on dialysis. Am J of Kidney Dis 2008; 51: 1029–1032.
44.
Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, Libermann TA, Morgan JP, Sellke FW, Stillman IE, Epstein FH, Sukhatme VP, Karumanchi SA: Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 2003; 111: 649–658.
45.
Cornelis T, Spaanderman M, Beerenhout C, Perschel FH, Verlohren S, Schalkwijk CG, van der Sande FM, Kooman JP, Hladunewich M: Antiangiogenic factors and maternal hemodynamics during intensive hemodialysis in pregnancy. Hemodial Int 2013; 17: 639–643.
46.
Beardmore KS, Morris JM, Gallery ED: Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy 2002; 21: 85–95.
47.
Shehab N, Lewis CL, Streetman DD, Donn SM: Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med 2009; 10: 256–259.
48.
Ross LE, Swift PA, Newbold SM, Bramham K, Hurley A, Gallagher H: An alternative approach to delivering intensive dialysis in pregnancy. Perit Dial Int 2016; 36: 575–577.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.