ORGANUM
There are many pre-existing diseases in pregnancy, and there may be an impact on the pregnancy from the disease, or a impact on the disease from the pregnancy. An increasing number of women are now entering pregnancy with pre-existing medical conditions. Ideally, these women should be offered preconception counselling to allow the implications of pregnancy with their specific medical condition to be discussed and a plan put in place.
Pregnancies complicated by chronic renal disease are rare (0.15%); however, they are associated with a significant risk of adverse maternal and fetal outcomes. In the majority of cases, the risks and management relate to the degree of renal impairment and not to the underlying cause of the renal disease.
In women with chronic renal disease, pregnancy can cause a deterioration of renal function. Mostly, this will recover after the end of the pregnancy, but for some women this will lead to a permanent reduction in renal functioning and a shorter time to end-stage renal failure. The likelihood of renal deterioration depends on baseline creatinine:
Serum creatinine (mmol/L) | Loss of >25% renal function in pregnancy (%) | Deterioration of renal function postpartum (%) | |
|---|---|---|---|
Mild renal impairment | <125 | 2 | 0 |
Moderate renal impairment | 124-168 | 40 | 20 |
Severe renal impairment | >177 | 70 | 50 |
Renal disease is associated with increased risks of pre-eclampsia, IUGR, preterm birth and a c-section birth. The risks of adverse outcome are related to the degree of renal impairment, the presence of hypertension and the presence of proteinuria. Most women with mild renal impairment will have good outcomes.
Women with CKD should ideally be seen for a pre-pregnancy counselling to discuss the implications of a potential pregnancy so that informed decisions can be made. For some women, the risk of deterioration to ESRF and a requirement for dialysis will be too great to undertake a pregnancy.
Pregnant women with renal disease should be offered care in MDT clinics that include an obstetrician and a renal physician. Initial review should involve assessment of baseline renal function, blood pressure and proteinuria. Prophylactic aspirin (150mg) from 12 weeks until delivery should be offered to reduce the risk of PET. Women already on antihypertensive