E HEWAWASAM1,2, C E DAVIES1,2, A GULYANI3, Z LI5, P A CLAYTON1,2,4, E SULLIVAN5, S MCDONALD1,2,4, S JESUDASON2,3
1Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia, 2Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia, 3School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia, 4Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, Australia, 5Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
Aim: We aimed to ascertain fertility rates in women receiving kidney replacement therapy (KRT, dialysis or kidney transplantation).
Background: Pregnancy in women receiving KRT is uncommon but high-risk. The Australia and New Zealand Dialysis and Transplant (ANZDATA) registry collects parenthood data, but may be subject to reporting bias.
Methods: Data from the ANZDATA was linked to perinatal datasets (all births from 1991-2013, ≥20 weeks gestation or birthweight ≥400 grams), in four Australian jurisdictions and fertility rates were calculated.
Results: Of 2,948,084 births, 248 babies were born to 168 mothers receiving KRT. Of these, 37 babies were born to 31 mothers receiving dialysis at conception or during pregnancy, while 211 babies were born to 137 transplanted mothers. The fertility rates were significantly lower for women receiving KRT, to a greater extent for dialysed women (5.8 births per 1000 women year (BPTWPY) (95% CI: 4.1-8.1)) than transplanted women (21.4 BPTWPY (95% CI: 18.6-24.6)), compared to the women who were not receiving KRT at the time of birth (61.9 BPTWPY (95% CI: 61.8-62.0)). Among KRT women, fertility rates were significantly lower for women from other ethnic backgrounds (Indigenous, Asian, African and Middle Eastern women) and women with pre-existing diabetes compared to their counterparts after adjusting for the treatment modality and maternal age. For births conceived after KRT, the fertility rate was significantly higher in the women exposed to KRT for >3 years compared to those exposed to KRT for ≤3 years, after adjusting for the treatment modality and maternal age.
Conclusions: Fertility rates were significantly lower in KRT women, particularly in dialysed women, and influenced by ethnicity, pre-existing diabetes and the total duration of KRT exposure.
Dr Erandi Hewawasam is a Postdoctoral Research Fellow at ANZDATA within the SA Health and Medical Research Institute (SAHMRI). She is coordinating a body of research to investigate parenthood outcomes in women and men with kidney disease using a broad range of methodologies (data linkage, registry, cohort and qualitative studies). In particular, she is currently leading the registry’s multi-jurisdictional data linkage study- Parenthood in patients receiving dialysis or kidney transplantation: Perinatal risks and outcomes. Erandi has completed a PhD in Science at the University of Adelaide and SAHMRI, focusing on the effects of fish oil in preterm born children.