[Pregnancies in hemodialysis and in patients with end-stage chronic kidney disease : epidemiology, management and prognosis]

Pregnancy Among Women Receiving Chronic Dialysis in France (2006-2020)

Introduction

In women receiving chronic dialysis, fertility is impaired. The objectives of this study were to estimate the incidence rate of pregnancies among women of childbearing age (15-50 years) receiving chronic dialysis from 2006 to 2020 in France, to describe the pregnancy outcomes and renal management during pregnancy.

Methods

This national observational, retrospective study was based on data from the French REIN registry matched with the National Health Data System.

Results

Over the period 2006 to 2020 in France, 348 pregnancies were identified in 240 women receiving chronic dialysis. The overall incidence of pregnancy was 11.1, 95% confidence interval (CI) (9.9-12.3) cases per 1000 person-years. Hemodialysis was the predominant modality during pregnancy. Main maternal complications were preeclampsia (n = 19) and gestational diabetes (n = 11). The most obstetric complications were premature rupture of membranes (n = 14) and polyhydramnios (n = 5). These pregnancies resulted in 174 (50%) abortions (<22 weeks), including 104 elective abortions (29.9%), 44 miscarriages (12.6%), 17 therapeutic abortions (4.9%), 5 ectopic pregnancies (1.4%), and 4 hydatidiform moles (1.2%). The remaining 174 (50%) pregnancies with deliveries (≥22 weeks) resulted in 166 live births (70 full-term [42.2%], 96 preterm births [57.8%]), and 8 stillbirths. Median gestational age was 36 weeks (32-38) for 174 deliveries.

Conclusion

There have been improvements in maternal and fetal outcomes regarding pregnancy on chronic dialysis. However, our study shows a significant proportion of elective abortions. Better fertility management of women receiving chronic dialysis is advised by contraception or by pregnancy planning and early multidisciplinary follow-up.

[Management of alport syndrome during pregnancy: a case study and literature review]

La survenue d'une grossesse chez une patiente porteuse d'un syndrome d'alport est une situation rare vu les répercussions de cette néphropathie sur la fertilité. Nous rapportons un cas de syndrome d'alport associé à la grossesse chez une parturiente âgée de 28 ans. La survenue d'une menace d'accouchement prématuré avec une élévation des chiffres tensionnels a nécessité l'hospitalisation de cette femme pour une éventuelle prise en charge. Une revue de la littérature discutant les différentes complications materno-fœtales et s'intéressant á la prise en charge au cours de la grossesse est également présentée.