Pregnancy in women on haemodialysis and peritoneal dialysis

Pregnancy in women with renal insufficiency and end-stage renal disease, while uncommon, is definitely possible, and such women should not assume they are infertile. Contraception should be prescribed for those who do not want to conceive. For the woman who is dialysed during pregnancy, the risks can be minimized by aggressive blood pressure control and prompt diagnosis and treatment of bleeding episodes; however, no degree of vigilance can guarantee that a woman will not suffer any of the severe complications that have been described in pregnant dialysis patients. Intensive dialysis should be undertaken to maintain chemistries that are as nearly normal as possible, and premature labour should be treated with indomethacin. Our current state of knowledge suggests that the success rate of pregnancy in dialysis patients is no better than 52%. It remains to be seen whether CAPD and erythropoietin improve the currently poor outcome. While transplantation offers the best chance of child bearing for women with end-stage renal disease, transplantation is not always possible. Thus we no longer discourage women on dialysis from becoming pregnant as long as they understand that the likelihood of success is small and that serious risks are involved, and as long as they are willing to follow the time-consuming regimen we think it is necessary for their safety. We hope that, in time, increased experience with pregnant dialysis patients will lead to more successful outcomes and that the possibility of parenthood will be added to the improved quality of life in these women.