Successful pregnancies in women on renal replacement therapy: Report from the EDTA Registry

Abstract

Abstract. This study reports the geographical incidence of successful pregnancies in women on renal replacement therapy (RRT) and related information on gestation and clinical status of newborns. The impact of successful pregnancy on graft function was assessed by means of a retrospective case-control study.Since 1977 special questionnaires have been sent to each dialysis and transplant centre which reported babies born to mothers on RRT on the yearly centre questionnaire. After 10 years of data collection, a total of 490 pregnancies and 500 babies were available for analysis. A percentage of 88.4 of the babies were born to mothers with a functioning graft, 11.2% to mothers on chronic haemodialysis, and the remaining 0.4% to mothers on CAPD.Almost 50% of all successful pregnancies wereCorrespondence and ojfprint requem to: Professor F. P. Brunner, EDTA Registry, St Thomas' Hospital, London SE1 7EH, UK.reported from the UK. The number of successful pregnancies increased steadily and in parallel with the increasing number of females of childbearing age with a functioning renal transplant. The majority of mothers delivered at age 24-32. For transplanted mothers delivery occurred most commonly during the 3rd and 4th year after successful transplantation. In approximately 85% of cases the duration of pregnancy was shorter than the lower 10th percentile of normal. Birthweight was reduced in accordance with gestational age. Newborn mortality was 1.8%.Fifty-three mothers with a successful pregnancy in 1984 1987 were computer matched with controls according to a number of criteria. The serum creatinine concentration recorded in coded form at the end of each year on the individual EDTA patient questionnaire was used to assess changes in graft function. In 94% of these cases the serum creatinine, recorded 0 11 months before delivery, did not exceed 160 umol/1. Graft function deteriorated in 18% of 280 G. Rizzoni el ai mothers as compared to 24% of controls. Twentyfour to 36 months postpartum, changes of serum creatinine were similar in test cases and controls, suggesting that a successful pregnancy does not adversely affect graft function if this was stable and well preserved at the time of conception.

Sexual and Reproductive Function in Chronic Kidney Disease and Effect of Kidney Transplantation

“…Conception is rare for women on dialysis, and occurs at a rate of one in every 200 patients (Rizzoni, Ehrich et al 1992). Pregnancy is often diagnosed late because of menstrual irregularities; thus, early spontaneous abortion may be overlooked.…”

Pregnancy in Renal Transplant Recipients

“…Most studies reporting pregnancy outcome in women with kidney transplants are single-centerbased and retrospective, may span $2 decades, and the majority include ,50 pregnancies (4,5). Four voluntary registers have collected data (6)(7)(8)(9) in larger numbers of women, but are reliant on self-reporting.…”

Pregnancy after Kidney Transplantation

“…Three of these registries have reported the largest numbers to date and include in United States the National Transplantation Registry (NTPR), a voluntary registry initiated in 1991 that relies on transplant center or patient self-reporting (4); the United Kingdom Registry, which has collected information on the majority of transplantation units in the United Kingdom from 1997 to 2002 (5,6), and the European Dialysis and Transplant Association Registry, which collected information on outcomes from European countries (7). The NTPR registry has reported approximately 1500 outcomes in female and 1000 outcomes in male transplant recipients (4), the European Dialysis and Transplant Association has reported approximately 400 pregnancies in renal transplant recipients, and the UK Registry has reported data on outcomes of approximately 200 transplant recipients.…”