Chronic renal insufficiency in pregnancy

Area of Science:

• Nephrology
• Obstetrics
• Reproductive Medicine

Background:

• Pregnancy in women with chronic renal insufficiency and end-stage renal disease presents unique challenges.
• Management of risks is crucial for both maternal and fetal well-being.

Purpose of the Study:

• To assess the risks associated with pregnancy in women with chronic kidney disease (CKD).
• To evaluate management strategies and outcomes in pregnant women with renal insufficiency, dialysis, and transplant recipients.

Main Methods:

• Review of existing literature on pregnancy outcomes in women with varying degrees of renal impairment.
• Analysis of risk factors, complications, and management protocols.

Main Results:

• Women with serum creatinine >125 mmol/l face increased risks of renal function deterioration, hypertension, pre-eclampsia, and obstetric complications.
• Rigid hypertension control is vital; angiotensin-converting enzyme inhibitors are contraindicated.
• Fertility improves post-transplantation; immunosuppressants are not linked to congenital anomalies.
• Increased risks of prematurity and intrauterine growth restriction exist across all groups.
• Infant survival rates range from 80-100% for renal insufficiency and transplant recipients, but approximately 50% for women conceiving after dialysis.

Conclusions:

• Successful pregnancy in CKD requires meticulous management of hypertension and associated risks.
• Renal transplantation significantly improves fertility and pregnancy outcomes compared to dialysis.
• While risks are elevated, a substantial percentage of pregnancies result in surviving infants with appropriate care.