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      Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery

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          Abstract

          Pregnancy in women with chronic kidney disease has always been considered as a challenging event both for the mother and the fetus. Over the years, several improvements have been achieved in the outcome of pregnant chronic renal patients with increasing rates of successful deliveries. To date, evidence suggests that the stage of renal failure is the main predictive factor of worsening residual kidney function and complications in pregnant women. Moreover, the possibility of success of the pregnancy depends on adequate depurative and pharmacological strategies in patients with end-stage renal disease. In this paper, we propose a review of the current literature about this topic presenting our experience as well.

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          Major congenital malformations after first-trimester exposure to ACE inhibitors.

          William Cooper, Sonia Hernandez-Diaz, Patrick G Arbogast … (2006)
          Use of angiotensin-converting-enzyme (ACE) inhibitors during the second and third trimesters of pregnancy is contraindicated because of their association with an increased risk of fetopathy. In contrast, first-trimester use of ACE inhibitors has not been linked to adverse fetal outcomes. We conducted a study to assess the association between exposure to ACE inhibitors during the first trimester of pregnancy only and the risk of congenital malformations. We studied a cohort of 29,507 infants enrolled in Tennessee Medicaid and born between 1985 and 2000 for whom there was no evidence of maternal diabetes. We identified 209 infants with exposure to ACE inhibitors in the first trimester alone, 202 infants with exposure to other antihypertensive medications in the first trimester alone, and 29,096 infants with no exposure to antihypertensive drugs at any time during gestation. Major congenital malformations were identified from linked vital records and hospitalization claims during the first year of life and confirmed by review of medical records. Infants with only first-trimester exposure to ACE inhibitors had an increased risk of major congenital malformations (risk ratio, 2.71; 95 percent confidence interval, 1.72 to 4.27) as compared with infants who had no exposure to antihypertensive medications. In contrast, fetal exposure to other antihypertensive medications during only the first trimester did not confer an increased risk (risk ratio, 0.66; 95 percent confidence interval, 0.25 to 1.75). Infants exposed to ACE inhibitors were at increased risk for malformations of the cardiovascular system (risk ratio, 3.72; 95 percent confidence interval, 1.89 to 7.30) and the central nervous system (risk ratio, 4.39; 95 percent confidence interval, 1.37 to 14.02). Exposure to ACE inhibitors during the first trimester cannot be considered safe and should be avoided. Copyright 2006 Massachusetts Medical Society.
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            Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery.

            Amalia Levy, Drora Fraser, Moshe Mazor … (2005)
            The present study was designed to investigate the outcome of pregnancy and delivery in patients with anemia. A retrospective population-based study comparing all singleton pregnancies of patients with and without anemia was performed. Deliveries occurred during the years 1988-2002 in the Soroka University Medical Center. Maternal anemia was defined as hemoglobin concentration lower than 10 g/dl during pregnancy. Patients with hemoglobinopathies such as thalassemia were excluded from the analysis. Multiple logistic regression models were performed to control for confounders. During the study period there were 153,396 deliveries, of which 13,204 (8.6%) occurred in patients with anemia. In a multivariable analysis, the following conditions were significantly associated with maternal anemia: placental abruption, placenta previa, labor induction, previous cesarean section (CS), non-vertex presentation and Bedouin ethnicity. Higher rates of preterm deliveries (<37 weeks gestation) and low birthweight (<2500 g) were found among patients with anemia as compared to the non-anemic women (10.7% versus 9.0%, p < 0.001 and 10.5% versus 9.4%, p < 0.001; respectively). Higher rates of CS were found among anemic women (20.4% versus 10.3%; p < 0.001). The significant association between anemia and low birthweight persisted after adjusting for gender, ethnicity and gestational age, using a multivariable analysis (OR = 1.1; 95% CI 1.0-1.2, p = 0.02). Two multivariable logistic regression models, with preterm delivery (<37 weeks gestation) and low birthweight (<2500 g) as the outcome variables, were constructed in order to control for possible confounders such as ethnicity, maternal age, placental problems, mode of delivery and non-vertex presentation. Maternal anemia was an independent risk factor for both, preterm delivery (OR = 1.2; 95% CI 1.1-1.2, p < 0.001) and low birthweight (OR = 1.1; 95% CI 1.1-1.2, p = 0.001). Maternal anemia influences birthweight and preterm delivery, but in our population, is not associated with adverse perinatal outcome.
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              Chronic kidney disease in pregnancy.

              David Williams, John Davison (2008)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Kidney J
                Journal ID (iso-abbrev): Clin Kidney J
                Journal ID (publisher-id): ckj
                Journal ID (hwp): ndtplus
                Title: Clinical Kidney Journal
                Publisher: Oxford University Press
                ISSN (Print): 2048-8505
                ISSN (Electronic): 2048-8513
                Publication date (Print): June 2015
                Publication date (Electronic): 19 March 2015
                Publication date PMC-release: 19 March 2015
                Volume: 8
                Issue: 3
                Pages: 293-299
                Affiliations
                [1 ]Department of Nephrology, “A. Perrino” Hospital of Brindisi and “D. Camberlingo” Hospital , Francavilla Fontana, Italy
                [2 ]Gynecology and Obstetrics Unit, “D. Camberlingo” Hospital , Francavilla Fontana, Italy
                [3 ]Nephrology and Dialysis Unit, “D. Camberlingo” Hospital , Francavilla Fontana, Italy
                [4 ]Nephrology and Dialysis Unit, “A. Perrino” Hospital , Brindisi, Italy
                Author notes
                Correspondence to: Luigi Vernaglione; E-mail: vernalu68@ 123456gmail.com
                Article
                Publisher ID: sfv016
                DOI: 10.1093/ckj/sfv016
                PMC ID: 4440463
                PubMed ID: 26034591
                SO-VID: f666a9c8-de47-4444-be92-3b51fc05c1e0
                Copyright © © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 6 December 2014
                Date accepted : 26 February 2015
                Categories
                Subject: Contents
                Subject: Dialysis in Special Situations

                ScienceOpen disciplines: Nephrology
                Keywords: esrd,delivery,haemodialysis,live birth,pregnancy
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: esrd, delivery, haemodialysis, live birth, pregnancy

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