Pregnancy and kidney dialysis

Women with kidney disease who are on dialysis may wonder how dialysis will affect their chances of getting pregnant and delivering a healthy baby. Studies show that only 1 to 7 percent of women of childbearing age on dialysis can get pregnant. Over 90 percent of women of childbearing age on dialysis cannot get pregnant because having kidney disease can decrease the ability to produce healthy eggs that can be fertilized. Also, some women on dialysis may not menstruate or if they do, they have irregular periods. This is caused by irregular hormone levels in the body.

While it is rare, women on dialysis have become pregnant. Of these pregnancies, about 20 percent will end in miscarriage. A full-term pregnancy lasts about 40 weeks; however, about 80 percent of dialysis pregnancies will only go about 32 weeks, resulting in a premature birth.

Is pregnancy recommended for women on dialysis?

Pregnancy is generally not recommended for dialysis patients because it is considered a high-risk pregnancy. Healthy kidneys work all day everyday, yet in-center hemodialysis is only about 12 hours per week and replaces only a portion of kidney function. The body of someone on dialysis has a higher level of waste products than a body with good kidney function. Having extra wastes in the body makes it harder for the baby to develop as it should.

During pregnancy, healthy kidneys must work overtime to keep the blood clean because the baby releases wastes into the mother’s blood stream, and she also has an increased amount of blood in her body. So, for women on dialysis whose kidneys don’t work, pregnancy is even harder on the body, and more frequent dialysis is recommended to keep the blood as clean as possible.

How can a woman on dialysis improve her chances of having a baby?

If a woman on dialysis wishes to have a baby or discovers she is pregnant, she should talk to her doctor about her individual condition. Her doctor will be able to explain the risks involved and be able to provide guidance to increase the chances of keeping the woman healthy and to help her carry her baby to term.

The chances of a woman with kidney disease becoming pregnant are higher if she has just recently started dialysis and still has a fair amount of residual kidney function or if she has had a transplant because she is more likely to be in better health and have a regular menstrual cycle.

A woman’s fertility will usually return to normal after a successful kidney transplant. Typically, she will have more regular periods and better general health compared to a woman on dialysis. It is easier for a woman with a transplant to get pregnant and have a child than a woman on dialysis. Statistics show that 20 percent of female kidney transplant patients attempting to get pregnant conceive compared to 1 to 7 percent of women on dialysis.

After receiving a transplant, it is important to wait until the transplant surgery scar has begun to heal before resuming sexual activity. Once the doctor says it is alright, there is no reason to worry about damaging the transplanted kidney.

However, pregnancy is not recommended for at least one year after a kidney transplant, even with stable kidney function. (Some sources recommend waiting as long as two to five years.) Women who have minimal protein in their urine, normal blood pressure and no evidence of kidney rejection are the best candidates for pregnancy.

In some cases, pregnancy is not recommended at all because of risk to the mother's life or possible loss of the transplant. A female transplant patient who is considering pregnancy should discuss any possible risks with her doctor.

Some women with chronic kidney disease or who are on dialysis have found that receiving erythropoietin (EPO) to treat anemia has improved their overall health, which can result in a greater chance of pregnancy. An improvement in overall health can lead to more energy for sexual activity, which can increase a woman’s chances of pregnancy.

When a dialysis patient becomes pregnant, she requires extra care and attention. She must work closely with her health care team, which includes her doctor, an obstetrician who specializes in high-risk pregnancy, a nephrologist (kidney doctor), a dialysis nurse, a pediatrician specializing in premature births and a renal dietitian. The baby’s progress should be continually monitored with ultrasounds to identify and treat problems early.

Many kidney disease patients have high blood pressure, which tends to get worse in pregnancy and often leads to miscarriage or premature delivery. The mother’s blood pressure must be monitored closely, because it could rise during pregnancy and cause problems for her and her baby. The expectant mother should take additional vitamins, eat a diet higher in protein and avoid alcohol and tobacco.

How often should a pregnant dialysis patient do dialysis treatments?

A pregnant woman on dialysis should increase the frequency of her dialysis treatments from three times to five or six times per week, depending on what her doctor suggests. More frequent dialysis is gentler on the mother’s body and less traumatic for the baby because more frequent dialysis more closely resembles the function of healthy kidneys. Blood pressure control is also better with more frequent dialysis.

More frequent dialysis allows the expectant mother to enjoy a varied and healthier diet. A healthy nutrient-dense diet during pregnancy is extremely important. Requirements are increased for protein and most vitamins and minerals, particularly folate and iron. The additional 300 calories a day needed during the second and third trimester is fairly easy for most women to meet. Pregnant women should work with their renal dietitian to evaluate their nutritional needs and come up with a diet plan.

If a woman is on in-center hemodialysis, it is recommended that she work with her health care team to increase the frequency of her dialysis treatments. She may want to consider switching to short daily home hemodialysis (HHD) or in-center nocturnal hemodialysis while she is pregnant so that she can do dialysis treatments more frequently. If she is currently doing home hemodialysis, it is recommended that she increase the frequency of her treatments so that her blood is getting cleaned almost daily. Pregnant women on dialysis are advised to have frequent ultrasounds to monitor the baby’s development and identify and treat any problems early and aggressively.

Peritoneal dialysis (PD) is also an option for pregnant women on dialysis, although some women may experience discomfort due to the growing baby and the dialysis fluid inside their abdomen. A PD catheter is not harmful to the baby and can be placed at any time during pregnancy. If a pregnant woman chooses PD, her doctor may decide to supplement her PD treatments with hemodialysis treatments as she gets closer to her due date to ensure that her blood is being cleaned as thoroughly as possible.

What kind of birth control is recommended for kidney patients?

Dialysis patients who have periods or those who could become pregnant should use birth control to guard against pregnancy. Doctors can recommend the type of birth control that should be used. Women who have high blood pressure should talk with their doctor before using a birth control pill, as some can raise blood pressure.

Women who want to have children are advised to consider using contraception while on dialysis and plan to have children after a kidney transplant. Some dialysis patients feel that they would be better able to care for a child after a kidney transplant, rather than when they are on dialysis because they will typically have more energy, feel better and have more free time because they do not have to go to dialysis treatments several times a week.

Transplant patients are advised not to use an intrauterine device (IUD), which is a small, plastic, T-shaped device that is inserted into the uterus to prevent pregnancy. Transplant patients are more likely to get an infection from an IUD because the anti-rejection drugs they must take lower the body’s ability to fight infection. Diaphragms, sponges and condoms are other forms of birth control that may be considered.

What emotional issues might couples go through if one of them is a dialysis patient and they can’t have a child?

A woman on dialysis may experience feelings of loss because she is unable to have a baby. She may feel incomplete or unfulfilled in her role as a woman, which may lead to feeling negative about herself and her sexuality. As a way of coping, she should talk openly about her feelings and needs with her partner and/or a health care professional.

With today’s cutting edge advances in fertility procedures, dialysis patients have more options than ever before. If a female patient is still ovulating, her eggs can be frozen and then fertilized with the sperm of her husband, partner or donor at a later date, and a surrogate can carry the pregnancy to term. Although some men experience a small decline in fertility while on dialysis, others experience reduced testosterone levels, reduced volume of seminal fluid, reduced sperm count or infertility. So, by the same token, a male dialysis patient can freeze his sperm for use at a later date. Dialysis patients can also experience parenthood by adopting or becoming a foster parent.