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Women with underlying chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes (AMAFO). CKD affects 4% of reproductive-age women, and is considered an independent risk factor for prematurity, low birth weight, neonatal death and preeclampsia, therefore, family planning should be offered to all CKD women of childbearing age
Objective:
The aim of this study was to determine the incidence of AMAFO in pregnant women with CKD on renal replacement therapy (RRT) and their reproductive status in our center.
Observational retrospective study of 30 patients with a diagnosis of CKD in hemodialysis (HD) and pregnancy from August 2017 to August 2023. Sociodemographic data, comorbidities, incidence of AMAFO, significant gynecological and obstetric history were recorded and analyzed.
The incidence of adverse maternal events was of 10 (33%), preeclampsia with severe features was the most frequent one (17%), followed by preeclampsia (7 %), HELLP syndrome (3%), gestational diabetes (3%), and placental abruption (3%). No deaths were reported during follow-up. There were 52 adverse fetal outcomes reported (84%), 90% with low birth weight, 40% with prematurity, 13 % with transient tachypnea of the newborn, 7% with premature rupture of the membranes, 7% with fetal distress, and 17% died. Regarding reproductive status among the CKD women, the average age at the beginning of active sexual life and menarche was 12 years, the average of pregnancies was 2, 51.7% of de patients were primigravida. The contraceptive method of choice are shown in graph 1 ; 26.7% of the patient did not accept any one.
In pregnant women with CKD in RRT the incidence of adverse maternal events was 33% and the incidence of adverse fetal events was 90%, with only 10% of pregnancies without any AMAFO. Family planning advice must be emphasized among women of reproductive age with CKD, since more than 25% of the women in this study did not accept a contraceptive method.