New research suggests that pregnancy outcomes are improving for women on dialysis or with a kidney transplant. Hayet Baouche, MPH, of APHP-Necker-Enfants Malades Hospital, REIN Registry in Paris, France and colleagues reported in Clinical Kidney Journal that from 2010 – 2020, the frequency women on dialysis becoming pregnant increased. There was a decrease in hypertensive disorders of pregnancy and polyhydramnios, as well as lower rates of neonatal and perinatal deaths compared to previous decades, likely attributed to advancements in obstetric and neonatal care, and progress in fetal monitoring and dialysis treatments. A systematic review of 14 retrospective and prospective studies was performed, representing 2,364 women on dialysis (92.6% hemodialysis; 7.4% peritoneal dialysis) and 2,754 pregnancies. They found the most common maternal complications to be preeclampsia, anemia, and hypertension, and also noted that patient age, obesity, and pre-existing hypertension also played a role in maternal and fetal outcomes.

In transplant patients, investigators looked at 5,408,215 hospital deliveries from 2009 – 2014 in the United States, where 405 women had stage 3-5 chronic kidney disease (CKD) and 295 women had functioning kidney transplants. Pregnant kidney transplant recipients had increased odds of hypertensive disorders of pregnancy, preeclampsia, eclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, acute kidney injury (AKI), fetal growth restriction, and preterm delivery compared with pregnant women without kidney disease, Vesna D. Garovic, MD, PhD, of Mayo Clinic in Rochester, Minnesota, and colleagues reported in Nephrology. Outcomes for pregnant women with a kidney transplant are significantly better than outcomes for pregnant women on dialysis though, leading researchers on Baouche’s team to recommend women of childbearing age on dialysis to wait for a kidney transplant before becoming pregnant.

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