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A Pause for Pregnancy

© Christine O'Connor

End stage renal failure brings along the probability of infertility in women.Though it is not fully understood why this happens, the majority of women in their childbearing years, find it difficult to conceive when the kidneys lose their functioning. Doctors would suggest to patients, to avoid pregnancy while on dialysis, and to wait until you have a working kidney from transplantation. Having said this, what are the possibilities and outcomes for bringing a child into the world when facing dialysis or transplantation.

Patients on dialysis face the least successful odds at both conceiving and carrying a baby to term. Approximate conception rates are less than 1% and survival rates for the infant are approximately only 40 to 50%. Those infants that do survive are usually born premature, weigh little and are small for their age or may have birth defects.

For the dialysis patient who is pregnant, it is recommended by most physicians to increase the dialysis treatments, sometimes to a daily regimen. This is thought to help the fluid overload problem that can cause high blood pressure and cause other problems for the patient when having to remove a lot of fluid at one time. It also helps to keep the body's chemistry changes from being so abrupt when having dialysis treatments only 3 times per week. This of course is better for the growing infant.

Most transplant recipients regain their ability to conceive. Pregnancy occurs in about 12% of these women. They have a much higher survival rate in bringing a baby to term, at approximately 70 to 100%. The immunosuppressive medications needed by a transplant patient are not know to increase birth defects, but may increase the chance of delivering a smaller infant.

Problems during the pregnancy of either a dialysis or transplant patient may include high blood pressure and the possibility of infections, especially in transplant patients, which may create problems for a growing baby. High blood pressure is the most common and the most life threatening to both mother and infant. All problems occurring during a pregnancy can be treated abruptly by your nephrologist to decrease any harmful effects to either you or your baby. In a small amount of transplant patients, a reduction in kidney function may occur, which may be permanent or may reverse itself.

Premature births are common to both dialysis patients and transplant recipients. Careful observation is required of the newborn. Premature babies in general may suffer from respiratory and other problems. Prematurity poses the greatest risk of death to infants that are born to mothers with renal disease.

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