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

PREDICTORS OF LIVE BIRTH IN WOMEN WITH KIDNEY FAILURE RECEIVING DIALYSIS: AN INDIVIDUAL PATIENT DATA ANALYSIS (#157)

Jolene Ng 1 2 , Meena Khandelwal 3 , Mary Bridgeman 4 , Merlijn Wind 5 , Lauren Walheim 6 , Theepika Rajkumar 1 , Angela Makris 1 2
  1. Department of Renal Medicine, Department of Obstetric Medicine, South West Sydney LHD, Sydney, Australia
  2. The University of New South Wales, Sydney, NSW, Australia
  3. Department of Obstetrics and Gynecology, Jefferson Maternal Fetal Medicine, Jefferson Health, Abington, Pennsylvania, USA
  4. Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
  5. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
  6. Department of Obstetrics & Gynecology, Pennsylvania Hospital, Philadelphia, PA, USA

Aim
To evaluate dialysis-related factors associated with live birth among women with kidney failure receiving dialysis.

Background
Pregnancy in women receiving dialysis remains associated with substantial maternal and neonatal morbidity. Factors associated with achieving live birth remain incompletely understood.

Methods
Individual patient data from 29 published cohorts (1988–2025) were pooled. Pregnancy outcomes were compared according to dialysis status at conception (pre-dialysis versus established dialysis) and haemodialysis intensity (<20 versus ≥20 hours/week). The primary outcome was live birth; secondary outcomes included gestational age, birth weight and prematurity. The full pregnancy cohort, including pregnancy losses, was analysed. Dialysis intensity analyses were restricted to haemodialysis pregnancies (n=146).

Results
A total of 242 pregnancies with available dialysis vintage data were included. Pregnancies conceived before dialysis initiation had higher live birth rates than those in women established on dialysis at conception (91.2% vs 74.0%; P=0.006) and longer overall gestation (33.0 vs 31.7 weeks; P=0.020). Among live births, gestational age, birth weight, prematurity, low birth weight and neonatal morbidity were similar between groups. Among women receiving haemodialysis, treatment intensity ≥20 hours/week was associated with higher live birth rates than <20 hours/week (91.5% vs 60.0%; P<0.001). A similar association was observed using a 24-hour threshold (91.4% vs 73.3%; P=0.009).

Conclusion
Conception before dialysis initiation and treatment with at least 20 hours of haemodialysis per week were associated with higher live birth rates. These findings support preconception counselling and optimisation of dialysis prescriptions during pregnancy.