Pregnancy and delivery in women receiving maintenance hemodialysis in Japan: analysis of potential risk factors for neonatal and maternal complications

Philip Hawke,Noriko Mori,Hirohiko Tani,Tomomi Ueda,Eiji Nakatani,Kenzo Kosaka,Hiroko Hirano,Kiyoshi Mori

doi:10.1007/s40620-021-01146-3

Philip Hawke, Noriko Mori + Show 6 more

Open Access

https://doi.org/10.1007/s40620-021-01146-3

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Abstract

IntroductionAverage dialysis vintage in Japan is among the longest in the world, providing a unique opportunity to characterize pregnancy under conditions of long dialysis vintage. In 2017, we carried out a nationwide survey following up on a similar survey in 1996, in which we investigated the prevalence and outcomes of pregnancy in women undergoing dialysis and assessed risk factors associated with neonatal and maternal complications.MethodsThe target population was women aged 15–44 years undergoing maintenance dialysis between 2012 and 2016. The survey was conducted in 2693 dialysis units.ResultsA response was obtained from 951 dialysis units, yielding a target population of 1992 women of childbearing age receiving hemodialysis or peritoneal dialysis. Pregnancy occurred only among women receiving hemodialysis, with 25 pregnancies (1.26% in 5 years) being reported for 20 women. Detailed information about 19 pregnancies (mean age 34.6 ± 5.7 years at conception, mean dialysis vintage 8.4 ± 7.3 years) indicated 4 spontaneous abortions, 1 elective abortion, no neonatal deaths, and 14 surviving infants, including 5 full-term (≥ 37 weeks at birth), 2 late preterm (34–36), and 3 extremely preterm (< 28) cases. Neonatal complications occurred in the offspring of 3 mothers who had end-stage renal disease (ESRD) caused by primary glomerulonephritis and serum albumin levels (sAlb) ≤ 3.2 mg/dL in the first trimester. These mothers had started dialysis at 12, 17, and 30 years of age. ESRD caused by diabetic nephropathy or primary glomerulonephritis, age at conception ≥ 38 years, and sAlb ≤ 3.2 mg/dL were associated with maternal complications, although not significantly.ConclusionsIn this study, the pregnancy rate of Japanese women with ESRD was 0.25% per year. The study generates the hypothesis that ESRD caused by diabetic nephropathy and age at conception ≥ 38 years are potential risk factors for maternal complications but not for neonatal complications in dialysis patients, and that hypoalbuminemia is a potential risk factor for both kinds of complications.Graphic

Highlights

Average dialysis vintage in Japan is among the longest in the world, providing a unique opportunity to characterize pregnancy under conditions of long dialysis vintage
The study generates the hypothesis that end-stage renal disease (ESRD) caused by diabetic nephropathy and age at conception ≥ 38 years are potential risk factors for maternal complications but not for neonatal complications in dialysis patients, and that hypoalbuminemia is a potential risk factor for both kinds of complications
All pregnancies occurred in patients on maintenance hemodialysis, with no peritoneal dialysis cases being reported

Summary

Introduction

Average dialysis vintage in Japan is among the longest in the world, providing a unique opportunity to characterize pregnancy under conditions of long dialysis vintage. Neonatal complications occurred in the offspring of 3 mothers who had end-stage renal disease (ESRD) caused by primary glomerulonephritis and serum albumin levels (sAlb) ≤ 3.2 mg/dL in the first trimester. These mothers had started dialysis at 12, 17, and 30 years of age. Compared to the general population and to renal transplant patients, women with end-stage renal disease (ESRD) undergoing dialysis are at greater risk of infertility, fetal death in early pregnancy period, and premature birth [1]. As dialysis access and vintage are much greater in Japan than in other countries, the Japanese situation provides a unique opportunity to study pregnancy under long-term dialysis

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