Nephrol Dial Transplant (1992) 7: 279-287
© 1992 European Renal Association-European Dialysis and Transplant Association
other
Successful pregnancies in women on renal replacement therapy: Report from the EDTA Registry
Ospedale Pediatrico Bambino Gesú, Istituto di Ricerca Scientifica Roma, Italy Medizinische Hochschule Hannover Germany Hôspital Necker Enfants Malades Paris, France Department für Innere Medizin,Universität Basel, Switzerland Department of Surgery 1, Sahlgrenska Sjukhuset Göteborg, Sweden Städtische Kliniken Fulda Germany Martini Ziekenhuis, Lokatie Van Swieten Groningen, Netherlands UK Transplant Service Bristol, United Kingdom Transplantation Unit, University Hospital Uppsala, Sweden St Thomas' Hospital London, United Kingdom
Correspondence and offprint requests to: Professor F. P. Brunner, EDTA Registry, St Thomas' Hospital, London SE1 7EH, UK.
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 werereported 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% ofmothers 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.
Keywords: renal replacement therapy; pregnancy; newborns
The data presented in this report have been published in part or in preliminary form in the Combined Reports on regular dialysis and transplantation of children 1986–1988.
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