Determinants of Perinatal Outcomes in Dialyzed and Transplanted Women in Australia.

Hewawasam, E; Davies, CE; Li, Z; Clayton, P; Sullivan, E; McDonald, SP; Jesudason, S

Determinants of Perinatal Outcomes in Dialyzed and Transplanted Women in Australia.

Hewawasam, E Davies, CE Li, Z Clayton, P Sullivan, E

McDonald, SP Jesudason, S

Permalink

Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Kidney International Reports, 2022, 7, (6), pp. 1318-1331
Issue Date:: 2022-06

Open Access

Copyright Clearance Process

Recently Added
In Progress
Open Access

This item is open access.

Adobe PDF

Download full textAdobe PDF (801.46 kB)

View on publisher's site

View statistics

Full metadata record

Field	Value	Language
dc.contributor.author	Hewawasam, E
dc.contributor.author	Davies, CE
dc.contributor.author	Li, Z
dc.contributor.author	Clayton, P
dc.contributor.author	Sullivan, E https://orcid.org/0000-0002-8718-2753
dc.contributor.author	McDonald, SP
dc.contributor.author	Jesudason, S
dc.date.accessioned	2022-10-27T05:09:59Z
dc.date.available	2022-03-11
dc.date.available	2022-10-27T05:09:59Z
dc.date.issued	2022-06
dc.identifier.citation	Kidney International Reports, 2022, 7, (6), pp. 1318-1331
dc.identifier.issn	2468-0249
dc.identifier.issn	2468-0249
dc.identifier.uri	http://hdl.handle.net/10453/162763
dc.description.abstract	Introduction: Drivers of adverse perinatal outcomes in pregnancies of women receiving chronic kidney replacement therapy (KRT) remain poorly understood. Methods: Births ≥ 20 weeks of gestation in Australian women receiving KRT were analyzed for perinatal outcomes stratified by maternal KRT exposure (dialysis or transplant, analyzed separately), by linking the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and perinatal data sets (1991-2013). Results: Of 2,948,084 babies (1,628,181 mothers), 248 were born to mothers receiving KRT (transplant, n = 211; dialysis, n = 37), with live birth rates ≥ 94%. The perinatal death rate was 162, 62, and 9 per 1000 births in the dialysis, transplant, and non-KRT cohorts, respectively. Babies exposed to KRT had increased odds of prematurity, small-for-gestational age (SGA), poor birth condition, resuscitation, intensive care admission, and longer hospitalization, with the dialysis cohort having worse outcomes. Preterm babies of dialyzed and transplanted mothers (compared with preterm babies with no KRT exposure) experienced 1.6- to 2.7-fold higher odds for all adverse outcomes, except birthweight < 2500 g, which was 11-fold higher for the dialysis cohort. In adjusted analyses, transplanted women with better allograft function (serum creatinine ≤ 120 μmol/l) still had >10-fold higher odds of preterm birth and low birthweight and 1.8- to 4.6-fold increased odds of other adverse outcomes. In transplanted women, mediation analysis revealed that pregnancy-induced hypertension contributed only a modest proportional effect (2.5%-11.2%) on adverse outcomes. Conclusion: Maternal dialysis and transplantation conferred excess perinatal morbidity, particularly for preterm babies, and even in women with good preconception allograft function. Pregnancy-induced hypertension is not the predominant determinant of perinatal morbidity. Preconception counseling of women with kidney disease should encompass discussion of perinatal complications.
dc.format	Electronic-eCollection
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Kidney International Reports
dc.relation.isbasedon	10.1016/j.ekir.2022.03.015
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Determinants of Perinatal Outcomes in Dialyzed and Transplanted Women in Australia.
dc.type	Journal Article
utslib.citation.volume	7
utslib.location.activity	United States
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2022-10-27T05:09:56Z
pubs.issue	6
pubs.publication-status	Published
pubs.volume	7
utslib.citation.issue	6

Abstract:

Introduction: Drivers of adverse perinatal outcomes in pregnancies of women receiving chronic kidney replacement therapy (KRT) remain poorly understood. Methods: Births ≥ 20 weeks of gestation in Australian women receiving KRT were analyzed for perinatal outcomes stratified by maternal KRT exposure (dialysis or transplant, analyzed separately), by linking the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and perinatal data sets (1991-2013). Results: Of 2,948,084 babies (1,628,181 mothers), 248 were born to mothers receiving KRT (transplant, n = 211; dialysis, n = 37), with live birth rates ≥ 94%. The perinatal death rate was 162, 62, and 9 per 1000 births in the dialysis, transplant, and non-KRT cohorts, respectively. Babies exposed to KRT had increased odds of prematurity, small-for-gestational age (SGA), poor birth condition, resuscitation, intensive care admission, and longer hospitalization, with the dialysis cohort having worse outcomes. Preterm babies of dialyzed and transplanted mothers (compared with preterm babies with no KRT exposure) experienced 1.6- to 2.7-fold higher odds for all adverse outcomes, except birthweight < 2500 g, which was 11-fold higher for the dialysis cohort. In adjusted analyses, transplanted women with better allograft function (serum creatinine ≤ 120 μmol/l) still had >10-fold higher odds of preterm birth and low birthweight and 1.8- to 4.6-fold increased odds of other adverse outcomes. In transplanted women, mediation analysis revealed that pregnancy-induced hypertension contributed only a modest proportional effect (2.5%-11.2%) on adverse outcomes. Conclusion: Maternal dialysis and transplantation conferred excess perinatal morbidity, particularly for preterm babies, and even in women with good preconception allograft function. Pregnancy-induced hypertension is not the predominant determinant of perinatal morbidity. Preconception counseling of women with kidney disease should encompass discussion of perinatal complications.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/162763