Possibility of Pregnancy with Kidney Disease!

Pregnancy is a transformative and joyous journey for women of childbearing age. However, for those with chronic kidney disease (CKD), the decision to conceive and the subsequent management of pregnancy present unique challenges. CKD, a condition characterized by impaired kidney function, requires careful consideration of potential risks and complications that may arise during pregnancy.

Understanding the impact of CKD on both the mother and the developing baby is crucial in ensuring the well-being of both individuals. In this blog, we will explore the complexities of pregnancy in the context of CKD, including the risks involved, the importance of pre-pregnancy planning, and the necessary precautions to safeguard the health of both the mother and the child. By delving into these topics, we aim to provide valuable insights and guidance for women with CKD who are contemplating or have embarked on the journey of motherhood.

During pregnancy, there is a common occurrence of salt accumulation and fluid retention, which places an additional burden on the kidneys. Certain conditions to watch out for during this period include elevated creatinine levels, proteinuria, and uncontrolled hypertension. These conditions can lead to acute or permanent damage. Therefore, precautionary measures such as kidney ultrasounds, urine routine examination/ACR (albumin creatinine ratio), and standard kidney function tests including urea, creatinine, sodium, and potassium should be conducted.

During this period, it is important to be aware of certain conditions that may be present, including:

1. Creatinine level exceeding 1.4 mg/dl
2. Presence of protein in the urine (proteinuria)
3. Uncontrolled hypertension (high blood pressure)

These conditions have the potential to cause acute or permanent damage to the kidney. Therefore, it is advisable to undergo precautionary tests such as kidney ultrasound, urine routine/ACR (albumin creatinine ratio), and standard kidney function tests including urea, creatinine, sodium, and potassium.

The following tests should not be overlooked before and after pregnancy:

Before Conceiving:  If you are undergoing gynaecologic treatment, it is important to undergo necessary tests such as complete hemogram, blood glucose profile, thyroid profile, basic kidney function tests (KFT), and urine ACR. These tests, in addition to other pregnancy-related tests, are crucial in avoiding chronic kidney disease and preventing growth retardation in the baby.

After Conceiving: After conceiving, it is recommended to have tests done for urea, creatinine, kidney ultrasound (USG), and proteinuria (urine routine/urine ACR) as per the Nephrologist instructions.

Patients with chronic kidney disease may experience the following complications:

1. Pre-eclampsia or gestational hypertension: Pre-eclampsia is a condition where blood pressure rises to levels above 140/90 after 20 weeks of pregnancy, accompanied by frothy urination (proteinuria). If left untreated, it can progress to eclampsia, which involves seizures. Additional symptoms include pedal swelling, uneasiness, eye swelling, vertigo, and generalized weakness. Risk factors for pre-eclampsia include obesity, multiparity, genetic predisposition, and abnormal placental position. Blood pressure should be monitored every 6 hours if it exceeds 140/90.
2. Gestational diabetes mellitus (GDM): GDM refers to an incidental increase in blood glucose levels during pregnancy. Normal blood sugar levels may be exceeded in fasting (> 110 mg/dl) and postprandial (> 130 mg/dl) states. Risk factors for GDM include PCOD, obesity, previous history of GDM, and maternal smoking habits. Tests to detect GDM include fasting, postprandial, and glucose intolerance tests. An HbA1c test with a value above 6.4 indicates pre-existing diabetes detected during pregnancy.
3. Preterm delivery: Preterm delivery occurs when a baby is born before completing the full term of 37 weeks in the mother’s womb. This can lead to underdeveloped organs such as the brain, kidneys, and liver, resulting in intrauterine growth retardation. Delivery is classified as full term (37-41 weeks) or preterm (< 37 weeks).
4. Low birth weight (LBW) babies: LBW babies are a consequence of chronic kidney disease. They have a birth weight of less than 2.5 kilograms and are often the result of preterm delivery. These babies struggle to gain weight properly in the uterus. They may also have difficulty breastfeeding, making them more susceptible to infections, diarrhea, malnutrition, and ultimately, growth retardation.

Risk factors for preterm delivery and Lowe body weight

Risk factors for preterm delivery and LBW babies include infections during pregnancy, inadequate weight gain during pregnancy, a history of LBW or preterm delivery, maternal age below 17 or above 35 years, and substance abuse (drugs and alcohol).

In conclusion, pregnancy in the presence of chronic kidney disease (CKD) requires careful consideration and consultation with healthcare professionals. The potential risks and complications associated with CKD during pregnancy are pre-eclampsia, gestational diabetes, preterm delivery, and low birth weight.  They emphasize the importance of proactive management and monitoring. Early-stage CKD may allow for safer pregnancies with appropriate management. Although late-stage CKD poses significant risks to both the mother and the child.

Transplant recipients with stable graft function may have the opportunity to plan for pregnancy after a year. Additionally, advancements in assisted reproductive technologies like surrogacy or ovum presentations provide alternative options for women facing challenges in conceiving due to CKD. It is essential for CKD patients to collaborate closely with nephrologists and gynecologists to make informed decisions and ensure the best possible outcomes for both the mother and the baby. Ultimately, personalized care and a comprehensive approach are key in navigating the complexities of pregnancy and CKD.