Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2026

Perinatal Outcomes and Maternal Characteristics in Pregnancies Fathered by Men Receiving Kidney Replacement Therapy: An ANZDATA Registry Linkage Study (#107)

Su Jen Chua 1 2 , Christopher E Davies 1 3 , Erandi Hewawasam 1 4 , Shilpa Jesudason 1 3 5
  1. Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry Parenthood Working Group, South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
  2. Mercy Perinatal, Heidelberg West, VICTORIA, Australia
  3. College of Health, Adelaide University, Adelaide, South Australia, Australia
  4. National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
  5. Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia

Introduction: Evidence on pregnancies fathered by men receiving kidney replacement therapy(KRT) is limited. Concerns remain on medication teratogenicity, particularly mycophenolic acid analogues(MPA)1,2. Through data linkage we were able to access the full maternal, obstetric and perinatal record for pregnancies fathered by these men.

Methods: Retrospective cohort study linking ANZDATA Registry (1970–2016) with perinatal datasets (1991–2013) across four Australian jurisdictions3. Outcomes of pregnancies fathered by men receiving KRT (dialysis or transplantation) at conception were compared to a non-KRT cohort.

Results: Of 2,844,991 parenthood events, 501 occurred in transplant recipients (51% MPA exposed) and 147 in dialysis patients. Paternal age at conception was similar between dialysis and transplant cohorts (median 33.6 years(IQR 30.4-37.9) versus 33.9(IQR 30.3-38.3), p=0.69). Time from start of KRT modality to conception was longer in transplant recipients compared to dialysis (median 8.0 years(IQR 4.7-12.9) versus 3.3(IQR 1.0-7.1), p<0.01). Mothers were slightly older in the transplant group than the dialysis group (32[IQR 28–35] versus 31[IQR 26–35] years, p<0.01), however, hypertensive disorders of pregnancy, live/term delivery, Apgar scores, or congenital abnormalities did not differ. Birthweight was slightly lower in the dialysis cohort compared to transplant and non-KRT cohorts (median 3268g(IQR 2940-3560) versus 3430g(IQR 3105-3780) versus 3400g(IQR 3060-3730), p<0.01). Fetal outcomes were comparable between pregnancies with versus without paternal MPA or calcineurin inhibitor exposure.

Conclusion: In the largest cohort with the longest follow-up to date, perinatal outcomes of pregnancies fathered by men on KRT were reassuring, with no adverse signals from MPA exposure.

 

  1. Mycophenolate mofetil. Safety advisory - new contraindications relating to pregnancy and breastfeeding. 21 December 2015.
  2. Mycophenolate: updated recommendations for contraception for men and women. 15 December 2017.
  3. Hewawasam E, Gulyani A, Davies CE, et al. Parenthood and pregnancy in Australians receiving treatment for end-stage kidney disease: protocol of a national study of perinatal and parental outcomes through population record linkage. BMJ Open. May 25 2020;10(5):e036329. doi:10.1136/bmjopen-2019-036329