Pregnancy in Autosomal Dominant Polycystic Kidney Disease: Maternal and Fetal Considerations: A Narrative Review

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder and an important cause of kidney failure among individuals of reproductive age. Although its management in nonpregnant adults is well established, the implications of ADPKD during pregnancy remain less clearly defined. The aim of this review is to summarize maternal and fetal risks and provide practical management considerations for pregnancy in individuals with ADPKD.

A narrative review of the literature was conducted using PubMed/MEDLINE and relevant clinical practice guidelines, focusing on pregnancy-related outcomes and management considerations in individuals with ADPKD.

Pregnant individuals with ADPKD face higher risks of chronic hypertension, proteinuria, hypertensive disorders of pregnancy, and preterm delivery compared with the general population. Strict blood pressure targets used outside of pregnancy may compromise uteroplacental perfusion, highlighting the importance of pregnancy-appropriate goals and safe antihypertensive choices. Renin-angiotensin system inhibitors and disease-modifying therapies such as tolvaptan are contraindicated due to fetal safety concerns. Monitoring strategies include regular assessment of blood pressure, kidney function, and fetal growth. Emerging imaging data suggest that pregnancy may accelerate kidney and liver cyst growth, although long-term consequences remain uncertain. Additional strategies such as low-dose aspirin, biochemical markers for preeclampsia risk assessment, and renal ultrasound for baseline evaluation may be considered.

Pregnancy in individuals with ADPKD requires individualized, multidisciplinary care with careful attention to blood pressure control, medication safety, and maternal and fetal monitoring. Further research is needed to better understand long-term outcomes and optimize management strategies.