Are you on dialysis and have a strong desire to have children? But you are unsure whether dialysis and pregnancy are compatible? This article informs you about what you need to consider, what difficulties and complications can arise and how dialysis in pregnancy generally works.
As a dialysis patient, can I get pregnant at all?
Women who require dialysis are much less likely to become pregnant due to reduced fertility. However, about one-tenth of women of fertile age who require dialysis still produce healthy egg cells and can therefore become pregnant.
How likely is it that pregnancy and dialysis will coincide?
Logically, a need for dialysis during pregnancy can occur in two different ways: either kidney failure occurs during an existing pregnancy, or a pregnancy occurs while you are already on dialysis.
However, dialysis pregnancies are generally quite rare. The reason for the low number is that dialysis often impacts other factors for women. These include, for example, loss of sex drive, irregular or absent menstrual bleeding and frequent failure to ovulate despite menstrual bleeding. As a result, dialysis pregnancies tend to occur unplanned in most cases. Please also keep in mind that pregnancies occur less frequently during peritoneal washing (PD) than during hemodialysis. On the other hand, it is important to know that successful pregnancies are more common after kidney transplantation than with all forms of dialysis.
It's best to plan a pregnancy with your kidney team from the beginning.
Dialysis during pregnancy - what you need to know!
If you need dialysis during pregnancy, it must be performed with special care. For this reason, you may have to spend more time per week on dialysis than pre-pregnancy or for non-pregnant people. By definition, your pregnancy as a dialysis patient is a high-risk pregnancy. It is recommended to have a team experienced with high-risk pregnancies available for consultation right from the start. A gynecologist, neonatologist and nephrologist may be a good choice.
During pregnancy, you may have significant complications if you are on dialysis. These include high blood pressure (=hypertension) or anemia. Anemia is when you have too few red blood cells in your blood - they are responsible for transporting oxygen in your body.
Successful pregnancies increased over the decades and are now about 86% in patients on intensified hemodialysis. The preterm birth rate is about 41%.
Complications in dialysis pregnancy - which ones can occur?
Pregnant women on dialysis are at particular risk. Primarily, the unborn child is exposed to the dangers of complications, however, these can also occur to a lesser extent for the mother.
High blood pressure is a problem and must be lowered at a controlled rate, otherwise blood supply to the unborn child could be affected. Another potential complication during pregnancy while on dialysis is anemia. Anemia can cause an undersupply of oxygen to the organs since there are too few red blood cells in your blood. This can be problematic to you as well as the unborn child. Try to avoid blood pressure values below 120/80 mmHG and above 140/90 mmHg.
As a pregnant person on dialysis, you also have a significantly increased risk of pre-eclampsia. Your medical team will be able to tell you how to prevent this. An elevated blood urea level can also lead to increased amniotic fluid in many cases of dialysis pregnancies.
Dialysis in pregnancy - does anything change?
If you do HD, there are a few things you should keep in mind to reduce your child's risk and your own risk. First of all, you should make sure that you only take or receive dialysis medications that are allowed during pregnancy. Particularly important are your blood pressure medications. Your dialysis and obstetrics team will of course help you here. It's best to go over all your medications with your care team right at the beginning of your pregnancy and at regular intervals from then on. You can also get advice on which medications you should avoid at all costs.
Your dialysis team may also recommend additional medications, such as vitamin supplements. Also, your dialysis time will usually be increased significantly. In some cases, dialysis time of at least 36 hours per week is recommended.
The situation is different if you do peritoneal dialysis (PD). Here, you need to be aware of a few special considerations. Pregnancy affects the volume in your abdomen. This makes the normal course of PD much more difficult. Nevertheless, it is not necessarily the case that you have to switch from PD to HD. You should use more bags with less fluids. Meaning, you will have to change the fluid more frequently. Of course, it is best to discuss such a therapy adjustment with your medical team. Alternatively, nocturnal PD via a cycler is also an option. Hygiene during PD is even more important during pregnancy. Peritonitis can lead to premature labor.
Diet and daily behavior are the same as what you would be advised to do if you were on dialysis without pregnancy. Just make sure to control your blood salts such as sodium, phosphate, potassium, magnesium and calcium particularly well. However, because of the increased dialysis intensity, these are often well under control, or even need to be replaced. You should also be sure to get enough vitamins and protein. The additionally recommended increased caloric intake in the second and third trimesters is usually not difficult to achieve.
What happens shortly before, or during the time of birth?
As a rule, the condition of you and your child will be intensively monitored around the birth in the clinic. Whether you need a C-section or not is usually an obstetric decision. A C-section is often recommended in the end.
How soon can I continue dialysis after pregnancy?
HD can be resumed very promptly after delivery, with the regimen switched back. With PD, however, your medical team will normally wait at least 24 hours after delivery before allowing you to dialyze again. PD can also be performed after a cesarean section.
Is the risk of pregnancy the same after a kidney transplant?
A successful kidney transplant means that you are no longer required to undergo dialysis. For this reason, the risks of pregnancy are much lower after a kidney transplant than during the dialysis regimen.
However, compared to "normal" pregnancies, your risk is still increased. It is recommended that you wait at least one year after a kidney transplant to conceive a child. Your anti-rejection medications need to be changed for pregnancy, otherwise there is a risk to your future child. Please consult with your medical team even before you try to get pregnant.
So as a woman on dialysis, can I get pregnant at all?
As you can see, pregnancy in women on dialysis can unfortunately be associated with significant health risks. These results in a higher probability of underdevelopment or maldevelopment of the child. Due to the increased health risk, for both child and mother, you might consider starting a pregnancy only after a kidney transplant.
How can I increase my chances of successfully conceiving as a dialysis patient?
First of all, you should approach your medical team and discuss this wish with them. Despite the risks described above, your medical team may know a few things you can do to increase your chances of a successful pregnancy. This includes, for example, an early switch to an intensified dialysis regimen.
But you can also actively contribute to successful fertilization yourself by maintaining a healthier general condition. A healthy amount of exercise, a healthy diet and good sleep will give you more physical energy. With a healthy diet, you could, for example, get a better handle on diabetes.
As described above, a kidney transplant also significantly increases the likelihood of a successful pregnancy and birth. During pregnancy, it is best to have your nephrologist, a dialysis specialist and a pediatrician specializing in preterm birth, as well as a gynecologist experienced in high-risk pregnancies and a nutritionist, by your side from the beginning. In order to detect any complications at an early stage, the progress of the pregnancy should also be monitored more frequently than usual via ultrasound and blood tests.
I am pregnant and on dialysis, what now?
First of all, take it easy. Despite all the listed and serious complications, pregnancy and bringing a new life into the world is something very special and, if successful, one of the greatest feelings of happiness. Therefore, contact your medical team at the dialysis center immediately. They will know what to do and how and when you will adjust your therapy accordingly. You can be sure that the medical teams will do everything they can to make the pregnancy a success together with you and to accompany you until the birth of your healthy child.
