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Chronic renal disease in pregnancy
Susan M Ramin1, Alex C Vidaeff, Edward R Yeomans
1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA. susan.m.ramin@uth.tmc.edu
Obstetrics and Gynecology
|December 2, 2006
Summary
Pregnancy outcomes for women with chronic kidney disease depend on renal insufficiency severity. Careful monitoring and multidisciplinary care are crucial for managing maternal and fetal health, especially with hypertension.
Area of Science:
- Nephrology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Chronic kidney disease (CKD) in pregnancy is rare, affecting 0.03-0.12% of pregnancies.
- Available data are primarily from observational studies, reviews, and expert opinion, lacking randomized trials.
Purpose of the Study:
- To review the impact of varying renal insufficiency on pregnancy outcomes in women with CKD.
- To highlight key maternal complications and live birth rates associated with CKD in pregnancy.
- To outline optimal management strategies and counseling for pregnant women with CKD.
Main Methods:
- Literature review of opinion, reviews, retrospective, and observational series.
- Analysis of maternal complications, live birth rates, and risk factors.
- Synthesis of management recommendations and drug considerations.
Main Results:
- Maternal complications include preeclampsia, worsening renal function, preterm delivery, anemia, hypertension, and C-section.
- Live birth rates range from 64% to 98%, influenced by renal insufficiency severity and hypertension.
- Proteinuria may indicate underlying renal insufficiency; hypertension increases adverse outcome risk.
Conclusions:
- Management requires a multidisciplinary team (maternal-fetal medicine specialist, nephrologist) at a tertiary center.
- Counseling on pregnancy outcomes and effects on renal function is essential.
- Avoidance of certain antihypertensives (ACE inhibitors, ARBs) is recommended due to teratogenic and fetal risks.
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