Vrouwen met nierschade. Waar moeten zij tijdens de zwangerschap op letten?
The arrival of a baby in the family is a very pleasant event. But if the mother-to-be suffers from kidney disease (albuminuria) or kidney failure, these are factors that can complicate the progression of the pregnancy and that is why this pregnancy needs special care.
Ideally, it is recommended to create a gestational follow-up plan in cooperation with the gynecologist and the nephrologist, with planned controls for early diagnosis and treatment in any possible event. The key questions for this matter to be answered are the following:
How common is Chronic Kidney Disease in pregnancy?
Chronic kidney disease is classified into five stages according to the level of renal function. The first two stages that relate to with mild renal insufficiency and / or albuminuria, account for nearly 3% of reproductive age women. In women with worse renal function (stages 3-4-5 - mainly associated with older and therefore non-reproductive ages), pregnancy is uncommon.
How does pregnancy affect pre-existing kidney disease?
Regarding renal function, an elevated creatinine (> 1.5 mg / dl) and uncontrolled hypertension are the major risk factors for permanent deterioration of renal function. According to available studies, the NATURE of the disease is not the most critical factor, but the level of renal failure. Numerous studies show that pregnancy does not affect renal development or will not affect it in a minor way, as far as pregnant women with CKD (1 & 2) and - creatinine <1.24-1.3 mg / dl and albuminuria <1000 mg, with or without well-regulated hypertension are concerned. In women with moderate impaired renal function (creatinine> 1.4 mg / dl – that account for a very small proportion of women of childbearing potential), the risk of deterioration of renal function during pregnancy is about 40%, with the deterioration remaining after giving birth to half of these women. The deterioration becomes even higher if there is hypertension and / or albuminuria that are not controlled.
What is the effect of CKD on pregnancy?
Women with mild CKD (kidney failure or albuminuria) are very likely to have a pregnancy without any complications. In moderate and severe CKD, they are more likely to experience gestational hypertension (pregnancy induced hypertension) or preeclampsia. With regard to the infant, preterm birth (<37th week) and low birth weight infant are the main complications affecting it. These risks increase if hypertension is uncontrolled or according to the degree of deterioration of the renal function at the beginning of pregnancy.
Is it safe for a woman with nephropathy to conceive?
There are only MINIMUM cases when the doctor advises a woman to avoid pregnancy. In a woman with nephropathy, the correct question is not WHY she should get pregnant but when she should conceive. The pre-birth regulation of hypertension (if any) and albuminuria in order for the pregnant woman to be fully aware of any complications guarantees the best results. Planning the pregnancy of a woman with nephropathy allows the woman to become pregnant under the appropriate hypertension and albuminuria conditions, with the use of the appropriate drugs for hypertension and albuminuria, retaining the best possible general health status.
Will I need extra medication for my pregnancy if I suffer from kidney disease?
This will be decided by the treating physician based on your background. In women with an increased risk of preeclampsia, a small dose of aspirin (100 mg) may be given at the beginning of pregnancy.
Finally, what should a woman with nephropathy do to conceive?
- She should inform her nephrologist and gynecologist of her intention.
- A pregnancy monitoring plan that differs little from that of a pregnancy-free nephropathy (e.g. more frequent blood pressure measurements, urine albumin measurements) should be developed.
- Be informed of any potential or less likely risks for their timely identification and their timely treatment for the possible safest pregnancy.
- Initial screening should include: measurement of blood creatinine, urea, urine albuminuria, as well as measurement and recording of blood pressure at rest, and creation of a blood pressure, body weight, as well as laboratory testing recording calendar.
- The level of renal insufficiency and / or renal disease is important, and not the cause.
- Women with mild illness (which account for the overwhelming majority) conceive without complications and without burdening their disease.
- When women with increased albuminuria and uncontrolled hypertension are tested, the likelihood of any complication is greatly reduced.
- The presence of nephropathy in reproductive age women must not in any case become an impediment to the successful course of the pregnancy, only proper medical follow - up and update is recommended.
Mesogeios Dialysis Centers Group Scientific Team
1.Fink JC, Schwartz SM, Benedetti TJ, Stehman-Breen CO. Increased risk of adverse maternal and infant outcomes among women with renal disease. Paediatr Perinat Epidemiol. 1998;12:277–287.
2.Cunningham FG, Cox SM, Harstad TW, Mason RA, Pritchard JA. Chronic renal disease and pregnancy outcome. Am J Obstet Gynecol. 1990;163:453–459.
3.Trevisan G, Ramos JC, Martins-Costa S, Barros EJ. Pregnancy in patients with chronic renal insuffiency at Hospital de Clinicas of Porto Alegre, Brazil. Ren Fail. 2004;26:29–34.
4.Fisher MJ, Lehnerz SD, Hebert JR, Parikh CR. Kidney disease is an independent risk factor for adverse fetal and maternal outcomes in pregnancy. Am J Kidney Dis. 2004;43:415–423.
5.Bar J, Orvieto R, Shalev Y, Peled Y, Pardo Y, Gafter U, et al. Pregnancy outcome in women with primary renal disease. Isr Med Assoc J. 2000;2:178–181.
6.A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy Gianfranca Cabiddu, Santina Castellino, Giuseppe Gernone, Domenico Santoro, Gabriella Moroni, Michele Giannattasio, Gina Gregorini, Franca Giacchino, Rossella Attini, Valentina Loi, Monica Limardo, Linda Gammaro, Tullia Todros, Giorgina Barbara Piccoli J Nephrol. 2016; 29(3): 277–303. Published online 2016 Mar 17. doi: 10.1007/s40620-016-0285-6Correction in: J Nephrol. 2017 Jun 15
7.Association between hypertensive disorders during pregnancy and end-stage renal disease: a population-based study I-Kuan Wang, Chih-Hsin Muo, Yi-Chih Chang, Chih-Chia Liang, Chiz-Tzung Chang, Shih-Yi Lin, Tzung-Hai Yen, Feng-Rong Chuang, Pei-Chun Chen, Chiu-Ching Huang, Chi-Pang Wen, Fung-Chang Sung, Donald E. Morisky CMAJ. 2013 Feb 19; 185(3): 207–213. doi: 10.1503/cmaj.120230
8.Women, renal disease and pregnancy Andrew Smyth, Milan Radovic, Vesna D. Garovic Adv Chronic Kidney Dis. Author manuscript; available in PMC 2014 Sep 1. Published in final edited form as: Adv Chronic Kidney Dis. 2013 Sep; 20(5): 402–410. doi: 10.1053/j.ackd.2013.06.004