Okundaye I, Abrinko P, Hou S
Department of Medicine, Section of Nephrology, Rush Presbyterian-St Luke's Medical Center, Chicago, IL 60612, USA.
Am J Kidney Dis. 1998 May;31(5):766-73. doi: 10.1016/s0272-6386(98)70044-7.
A total of 2,299 dialysis units listed by the Health Care Finance Administration were surveyed to determine the frequency and course of pregnancies in dialysis patients. The responses included 930 units caring for 6,230 females aged 14 to 44 years (1,699 receiving peritoneal dialysis and 4,531 receiving hemodialysis). Two percent of the female patients of childbearing age became pregnant over a 4-year period (2.4% of the hemodialysis patients and 1.1% of the peritoneal dialysis patients). The infant survival rate was 40.2% in the 184 pregnancies in women who conceived after starting dialysis and 73.6% in the 57 pregnancies in women who started dialysis after conception. In the subset of women in whom dialysis modality was known, infant survival was not significantly different between the hemodialysis and peritoneal dialysis patients (39.5% v 37%). There was a trend toward better infant survival in women who received dialysis > or = 20 hours per week and a weak correlation between number of hours of dialysis and gestational age (P = 0.05). Maternal complications included two maternal deaths and five intensive care unit admissions for hypertensive crisis. Seventy-nine percent of women had some degree of hypertension, and 32 had blood pressure higher than 170/110 mm Hg. Only 5.9% of women had a hematocrit greater than 30% throughout pregnancy. Twenty-six percent of women treated with erythropoietin (EPO) and 77% of women not receiving EPO required transfusions. Eleven infants had congenital anomalies and 11 had long-term medical problems. Eighty-four percent of infants born to women who conceived after starting dialysis were premature. The likelihood of a surviving infant resulting from pregnancy in dialysis patients is higher than previously observed. There is no preferred dialysis modality. There is a suggestion that increased dialysis time may improve outcome. Prematurity remains a major cause of morbidity and likely contributes to a high frequency of long-term medical problems in surviving infants.
对医疗保健财务管理局列出的总共2299个透析单位进行了调查，以确定透析患者怀孕的频率和过程。回复包括930个单位，这些单位照料6230名年龄在14至44岁的女性（1699名接受腹膜透析，4531名接受血液透析）。在4年期间，2%的育龄女性患者怀孕（血液透析患者为2.4%，腹膜透析患者为1.1%）。在开始透析后怀孕的女性的184次妊娠中，婴儿存活率为40.2%；在怀孕后开始透析的女性的57次妊娠中，婴儿存活率为73.6%。在透析方式已知的女性子集中，血液透析和腹膜透析患者的婴儿存活率无显著差异（39.5%对37%）。每周接受透析≥20小时的女性的婴儿存活率有提高的趋势，透析时长与孕周之间存在弱相关性（P = 0.05）。母亲并发症包括2例母亲死亡和5例因高血压危象入住重症监护病房。79%的女性患有某种程度的高血压，32名女性血压高于170/110 mmHg。整个孕期只有5.9%的女性血细胞比容大于30%。接受促红细胞生成素（EPO）治疗的女性中有26%以及未接受EPO治疗的女性中有77%需要输血。11名婴儿有先天性异常，11名有长期医疗问题。开始透析后怀孕的女性所生的婴儿中有84%为早产。透析患者怀孕后存活婴儿的可能性高于先前观察到的情况。没有首选的透析方式。有迹象表明增加透析时间可能改善结局。早产仍然是发病的主要原因，可能导致存活婴儿长期医疗问题的高发生率。
