E HEWAWASAM 1,2, C DAVIES 1,2, Z LI 3, P CLAYTON 1,2,4, E SULLIVAN 3, S MCDONALD 1,2,4, S JESUDASON 2,4
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, 3Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia, 4Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, Australia
Aim: To define birth outcomes in transplanted or dialysed mothers (KRT), compared to births occurring before a mother started KRT (before-KRT), and for mothers who never received KRT (non-KRT).
Background: Australian data on maternofetal outcomes in mothers who receive kidney replacement therapy (KRT) is limited.
Method: ANZDATA was linked to perinatal datasets (1991-2013) in four jurisdictions to analyse birth outcomes stratified by KRT exposure. .
Results: From 2,948,084 births (1,628,181 mothers), we identified 1196 babies born to mothers before KRT and 248 born after KRT commenced (transplant, n=211 babies). Pre-existing diabetes was more common in the before-KRT cohort (15.5%) than the KRT cohort (5.8%, p<0.001). Diabetic nephropathy was a common cause of kidney disease (n=191, 25.1%) in mothers before KRT than KRT cohort (n=11, 6.6%, p<0.001). Babies born to mothers before KRT had higher gestational age (mean difference, 95% CI: 1.8, 1.2-2.4 weeks, p<0.001) and birthweight (mean difference, 95% CI: 455.4, 322.5-588.2 grams, p<0.001), and were less likely to be admitted to neonatal intensive care or special care nursery (42.2% vs 52.4%, p<0.01) than the KRT cohort. These babies had lower livebirth rate (96.1% vs 99.4%, p<0.001), lower APGAR scores (26.9% vs 11.6%, p<0.001), needed resuscitation more often (54.6% vs 37.4%, p<0.001), with longer hospital stay (mean difference, 95% CI: 10.9, 8.5-13.3 days, p<0.001) than the non-KRT cohort; these outcomes were similar to the KRT cohort.
Conclusions: Fetal outcomes of babies born to mothers before KRT were worse compared to the non-KRT cohort, and generally similar to babies in the KRT cohort. Women with diabetic nephropathy rarely had babies after starting KRT. These findings are essential for evidence-based pregnancy planning and counselling during routine kidney care.
Dr Erandi Hewawasam is a Postdoctoral Research Fellow at the ANZDATA registry at the SA Health and Medical Research Institute. She is currently coordinating patient-centred research in pregnancy and chronic kidney disease using a number of methodologies including data-linkage, registry, cohort studies and surveys. Her vision is to improve parenthood outcomes for men and women with kidney disease by utilising evidence-based pathways for parenthood planning and care informed by robust data, patient and clinician perspectives.