Pregnancy with kidney failure and on dialysis
Pregnancy with kidney diseases
There are so many kidney diseases, that it is not possible to predict every possibility, so a woman wanting information should ask her own specialist. However, there are some generalisations that can be made.
Minor kidney disease
Minor kidney disease usually does not affect pregnancy at all. If a woman has normal kidney function and normal blood pressure with little or no protein in the urine, a pregnancy may proceed perfectly normally. An exception is in some women with a condition called lupus (Click here for information on Lupus & Pregnancy)
High blood pressure, normal kidney function
If a woman has high blood pressure, this is likely to get worse during pregnancy. Without careful monitoring this could cause problems to the child and mother. A woman with high blood pressure before pregnancy is very likely to deliver prematurely, because of a rise in blood pressure during later pregnancy.
Reduced kidney function
If a woman has reduced kidney function, the risks of pregnancy and the chances of successful outcome are reduced. If the reduction in kidney function is not major (say, a woman has half or more of normal kidney function, with a blood creatinine level of about 150 micromoles per litre), pregnancy is usually successful. However, once kidney function is down to a quarter or less of normal (with a blood creatinine level of about 300 micromoles per litre), there are likely to be more problems with high blood pressure and premature delivery. In addition, the kidney function in the mother may get worse during or just after the pregnancy. In extreme cases dialysis may need to be started.
The timing of pregnancy may need some planning for a woman with progressive kidney disease. It may be best to have a child whilst kidney function is quite good (say one half of normal). Waiting until kidney failure is advanced increases the risks, and some women decide to delay pregnancy until after they have received a kidney transplant, because of the risks to their own kidney function and because pregnancy on dialysis has a low success rate.
Medication and planning pregnancy
If a woman with kidney disease is planning a pregnancy, they should mention this to their medical team so that discussions can be had in advance. One important area for review will be medication. Even if someone is taking a number of drugs for high blood pressure and other problems, it is possible to have a successful pregnancy with little extra risk. However, some drugs are safer than others and it may be best to make some changes to medication before getting pregnant. Many kidney units now have special clinics where a kidney specialist and an obstetrician (doctor who specialises in childbirth) work together and can give the best advice.
Pregnancy whilst on dialysis
Women of childbearing age do not often get pregnant whilst on dialysis. This is because dialysis only replaces a small percentage of kidney function, so the body still has high levels of waste products, which interfere with egg production and the menstrual cycle. Once a woman becomes pregnant, high blood pressure almost always causes problems, leading to premature delivery.
In one study performed in the United States, 1.5% (between one and two in a hundred) of young women on dialysis became pregnant in a two year period. Half the pregnancies resulted in the birth of a live child. There were many miscarriages in early pregnancies, and some stillbirths. All living babies were born prematurely.
It is usually recommended that a woman on dialysis who is pregnant should have an increased dialysis dose, be monitored carefully for high blood pressure, and should have a good haemoglobin level maintained with erythropoeitin.
Women who want to have children should consider whether it would be better to use contraception whilst on dialysis, and plan to have children after a kidney transplant. While there are still risks, the likelihood of a successful pregnancy rises to over 70% (seven out of ten) from about 50% (five out of ten) on dialysis. Some women also feel that they would be better able to care for a child if they had a kidney transplant, rather than being on dialysis.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.