Neonatal outcome in pregnancies associated with renal replacement therapy

Pregnancy in women receiving renal replacement therapy is not without risk to the mother and fetus. This article reviews the information on fetal outcome in pregnancies associated with renal transplantation and dialysis. The incidence of neonatal mortality, prematurity, and small-for-gestational-age infants is increased in pregnancies associated with maternal renal replacement therapy. Conversely, there does not appear to be a significant increase in the rate of congenital malformations. Whereas the fetal risk for inheritable renal disease is clearly defined in most cases, the risk associated with a host of new immunosuppressive medications is poorly understood. In addition, the newborn may be at risk for abnormalities in water homeostasis caused by the large solute load transferred from the mother receiving dialysis and requires close observation. Continued accumulation of clinical data will permit women receiving dialysis or with a kidney transplant to make informed decisions about current or future pregnancies.