Multidisciplinary Team Care Is Crucial for Successful Outcomes for Pregnant Patients on Dialysis, Says Dr Silvi Shah

Patients on dialysis who are pregnant should be treated by a nephrologist, a maternal-fetal specialist, and a neonatologist due to the high-risk nature of the pregnancy, said Silvi Shah, MD, MS, FASN, assistant professor, Division of Nephrology and Hypertension, University of Cincinnati.

Transcript

What are some of the steps that can be taken to treat and monitor pregnant individuals on dialysis and improve the odds of a successful pregnancy?

One of the things is care by a multidisciplinary team is extremely, extremely important. They should be followed by a nephrologist or a kidney doctor. They should have maternal-fetal medicine, which is a high-risk obstetrician, and at the same time, they will likely need neonatology care, as well, because most of the babies who are born are low birth weights and are preterm. So, we really stress all these pregnancies to be monitored in a tertiary care center, which has a level 3 NICU [neonatal intensive care unit] there. So multidisciplinary care is extremely, extremely important to have successful outcomes.

Following delivery, how should treatment be adjusted and are there any postpartum complications that patients should be monitored for?

I think treatment after delivery, we just have to monitor both the mother and the baby very closely. Breastfeeding is safe, postpartum, if they are not on any medications, which can be teratogenic. It is usually encouraged in these women. We also have to make sure their blood pressure is under good control. If they had any history of preeclampsia or hypertension during pregnancy, we will have to monitor their blood pressure to make sure that is under good control.