CKD and pregnancy
If you have CKD (and you may not know it), pregnancy can worsen kidney function – and that decreased kidney function may interfere with the pregnancy. A woman with mild-to-moderate CKD who is considering becoming pregnant should discuss the possible risks with her nephrologist and obstetrician before trying to conceive.
Patients with more advanced CKD (CKD4-5) may have problems conceiving; and if they do become pregnant, the likelihood of going to term (i.e. producing a normal live baby) is reduced.
1. Risk assessment
Before becoming pregnant, women with CKD should undergo a thorough assessment of their kidney function, including measurement of blood creatinine and estimated glomerular filtration rate (eGFR).
2. CKD stage matters
The stage of CKD plays a significant role in pregnancy outcomes. Women with earlier stages (CKD1-2 and CKD3B) typically have fewer complications compared to those with more advanced CKD (CKD3A, CKD4-5).
3. Increased risk of high blood pressure (hypertension)
CKD increases the risk of developing high blood pressure (hypertension) during pregnancy. Hypertension can further damage the kidneys and increase the risk of complications such as preeclampsia.
4. Preeclampsia
Women with CKD are at a higher risk of developing preeclampsia, a condition characterised by high blood pressure and damage to other organs, such as the liver and kidneys. Preeclampsia can be life-threatening for both mother and the baby.
5. Reduced fertility
CKD affects fertility, making it more challenging for women to become pregnant. Irregular menstrual cycles and hormonal imbalances can contribute to fertility issues.
6. Increased risk of preterm birth
Women with CKD are more likely to have preterm birth. This can lead to complications for the baby, such as low birth weight and respiratory distress syndrome.
7. Close monitoring required
Women with CKD who become pregnant should be closely monitored by a team of nephrologists, obstetricians and specialist nurses; to manage their kidney function and address potential complications. They will require monthly BP checks, urine tests for protein, and blood tests initially – then weekly towards delivery.
8. Medication differences
Some medications commonly used to manage CKD, such as ACE inhibitors and angiotensin receptor blockers (ARBs), are not safe during pregnancy and should be discontinued. Alternative medications should be prescribed.
9. Postpartum care
After giving birth, women with CKD should continue to be monitored for any changes in kidney function, blood pressure, and overall health – for up to three months after child-birth.
10. Women on dialysis
Women on dialysis who become pregnant, are at increased risk for miscarriage, premature delivery, severe hypertension, and preeclampsia. A woman who undergoes successful kidney transplantation has a lower risk of these complications.
Thus it may be advantageous for a woman to delay becoming pregnant whilst on dialysis, if kidney transplantation in the near future is likely. Haemodialysis may need to be done six to seven times per week during pregnancy.
Summary
We have described how CKD affects pregnancy, and vice versa. We hope it has been helpful.
Other resource
Here is more information on CKD and pregnancy.
Last Reviewed on 4 April 2024