Pregnancy in women with kidney disease: Should or not?

Women with kidney disease who conceive and continue to become pregnant pose an adverse risk to the health of the mother and the fetus. Despite modern medicine and great progress in antenatal and neonatal care, the risks are still proportional to the degree of kidney dysfunction.

Women with kidney disease during pregnancy are relatively rare. Determining the exact prevalence of chronic kidney disease during pregnancy is difficult. Some studies have shown that, in pregnant women with kidney disease, the diagnosis of the condition before pregnancy is 0.03%.
Mild kidney failure often has a silent course, so it is difficult to detect the disease in its early stages.
Renal failure is not related to pregnancy because in fact women with severe renal failure are beyond childbearing age or are infertile.
Kidney failure is divided into 5 stages.
Stages 1 and 2 affect 3% of women of childbearing age (20-39 years old). Stages 3-5 affect 1 in 150 women of childbearing age, but because of reduced fertility and the rate of early miscarriage, pregnancy in this population is uncommon. Most women with chronic kidney disease during pregnancy have mild renal dysfunction, and pregnancy usually does not affect renal prognosis.
According to a study of 46 pregnancies in 38 women with chronic renal failure, 22% with pre-eclampsia, 22% preterm delivery, 13% fetal growth restriction, caesarean section rate is 24%.
The low complication rate in this study stems from the fact that nearly 90% of the women had only mild kidney failure. Chronic hypertension, precancerous conditions, anemia or fetal growth restriction, and preterm birth are common complications in pregnant women with mild to severe renal failure.
According to some studies, women with mild renal failure initially have an increased risk of renal function decline during pregnancy, about half of which remain affected after delivery.
Studying 26 subjects with moderate kidney disease, up to 62% had chronic hypertension, 58% had pre-eclampsia and 73% had anemia. In addition, about 80% of women with hypertension and mild kidney disease will have an increased risk of preeclampsia compared with 30% of women without hypertension and kidney disease. The rate of fetal growth restriction for these subjects is 35%, the rate of premature birth is 30%. Among those with severe renal failure, 82% had hypertension, 64% had pre-eclampsia and 100% had anemia, 43% had fetal growth restriction, and 86% had preterm birth.
Chronic hypertension puts pregnant women at risk for preeclampsia and impaired kidney function. This risk can be reduced as blood pressure improves.

Pregnancy outcomes in women with kidney failure undergoing dialysis have increased markedly over the years.
Newborn survival is better in women with kidney failure who start dialysis during pregnancy than in women who start dialysis after pregnancy.
Increasing dialysis time may improve neonatal abnormalities, but preterm birth remains a major cause of morbidity and long-term health effects in infants.
According to some studies, the infant survival rate for patients on dialysis during pregnancy is 30-50%.
Intensive dialysis provides better pregnancy outcomes for women with chronic kidney failure. The proposed approach is to increase the frequency of dialysis and maintain blood urea levels (<100 mg/ml) to reduce the risk of excess amniotic fluid and predict the risk of preterm birth.

Transplants often cause infertility in women with end-stage kidney disease.
About 12% of women with kidney failure of childbearing age are able to get pregnant after a transplant, the pregnancy success rate is over 90% after the first trimester.
First successful pregnancy recorded from a mother who received a kidney transplant from an identical twin. Since then, many successful pregnancies have been reported in kidney transplant recipients.
A study was conducted with 48 pregnancies in 24 implants, 68% of the subjects gave birth including 1 twin.
However, according to some recent studies, the pregnancy rate in kidney recipients is significantly lower than in the general population. The rate of pregnancy leading to sudden pregnancy loss also increased over time.
Research studies are uncertain about pregnancy and implantation including the patient's own health and long-term risks to the unborn baby. There is also no way to create an immunosuppressant or treat during pregnancy, especially when new agents appear, while still ensuring the safety of pregnancy.
The degree of kidney failure affects the pregnancy of pregnant women. Women with stage 1-2 kidney disease with uncontrolled hypertension and proteinuria affecting pregnancy outcome. Increased dialysis time improves maternal complication rates and improves pregnancy outcomes. Kidney transplant recipients have been conceiving for more than 50 years and the results obtained from the mother and the infant are mixed.
Vinmec Times City International General Hospital is one of the prestigious medical facilities, a reliable address for patients with chronic kidney failure. With modern equipment and a team of professional and enthusiastic medical staff, patients with chronic kidney failure will receive the best care and treatment to achieve the most optimal results, especially bringing hope for female patients with chronic kidney failure.

Article references source: ncbi.nlm.nih.gov