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Pregnancy rates for women on dialysis higher than previously thought, differ by race
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A recently published study determined that pregnancy is more common for women undergoing dialysis than has been indicated by previous reports. Furthermore, the likelihood of a pregnant woman undergoing dialysis differs by a variety of factors, including race.
“Most women are anovulatory once they initiate dialysis, even if regular menstruation is present,” Silvi Shah, MD, MS, FACP, FASN, assistant professor in the division of nephrology at the University of Cincinnati, and colleagues wrote. “Pregnancy in women undergoing dialysis is a challenging clinical scenario due to significant maternal and fetal morbidity [and] the conception rate is low ... Although advances have been made in the management of pregnancies in women receiving dialysis, small numbers of cases preclude a clear understanding of [associated] factors.”
Researchers retrospectively evaluated 47,555 women (aged 15 to 44 years) using data from the United States Renal Data System. Shah told Healio/Nephrology that this allowed for “the limitation of reporting bias from surveys or voluntary registries.”
In total, 2,352 pregnancies were identified, leading to a pregnancy rate of 17.8 per thousand person years. The highest rate was observed in women aged between 20 and 24 years (40.9 per thousand person years).
Regarding race and ethnicity, researchers found a higher likelihood of pregnancy in Native American (HR = 1.77), Hispanic (HR = 1.51) and black (HR = 1.33) women compared with white women. Other factors associated with a higher pregnancy rate included ESKD due to malignancy (HR = 1.64), hypertension (HR = 1.32) and secondary glomerulonephritis/vasculitis (HR = 1.18) vs. ESKD due to diabetes. Researchers also found women on PD were less likely to experience pregnancy than those on hemodialysis (HR = 0.47).
Comparing these results with a previous study, also led by Shah, she pointed out that the pregnancy rate was “interestingly” lower in kidney transplant recipients than in women on dialysis. In addition, among transplant recipients, Hispanic women — but not black women — had a higher likelihood of pregnancy.
Shah said the current study did not uncover the reasons behind these racial and ethnic differences and so further research is required, adding, “We were also not able to determine the differences in unintentional and intentional pregnancies and whether level of education was associated with the likelihood of pregnancy.”
Despite these uncertainties, she argued that “The study improves our understanding of various factors associated with pregnancy like race/ethnicity, ESKD cause and type of dialysis modality, [which] is particularly important during pre-pregnancy counseling and shared decision-making.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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