title: Perspectives on Pregnancy in Women With CKD: A Semistructured Interview Study.
abstract: BACKGROUND
  Women with chronic kidney disease (CKD) often have difficulty achieving pregnancy and are at increased risk for adverse pregnancy outcomes. Given the medical, ethical, and emotional complexities of pregnancy in CKD, the clinical approach should involve explicit consideration of women's values, for which there are sparse data. This study aims to describe the beliefs, values, and experiences of pregnancy in women with CKD to inform prepregnancy counseling and pregnancy care.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  41 women (95% response rate) aged 22 to 56 years with CKD stages 3 to 5 (n=5), receiving dialysis (n=5), or received a kidney transplant (n=31) from 2 renal units in Australia.
  
  
  METHODS
  Semistructured interviews.
  
  
  METHODS
  Transcripts were analyzed thematically.
  
  
  RESULTS
  6 themes were identified: bodily failure (conscious of fragility, noxious self, critical timing, and suspended in limbo), devastating loss (denied motherhood, disempowered by medical catastrophizing, resolving grief, barriers to parenthood alternatives, and social jealousy), intransigent guilt (disappointing partners, fear of genetic transmission, respecting donor sacrifice, and medical judgment), rationalizing consequential risks (choosing survival, avoiding fetal harm, responding to family protectiveness, compromising health, decisional ownership, and unjustifiable gamble), strengthening resolve (hope and opportunity, medical assurance, resolute determination, and reticent hope), and reorientating focus (valuing life and gratitude in hindsight).
  
  
  CONCLUSIONS
  Only English-speaking women were recruited, which may limit transferability of the findings.
  
  
  CONCLUSIONS
  Decisions surrounding pregnancy in the context of CKD require women to confront uncertainties about their own survival, disease progression, guilt toward their family and kidney donor, the outcomes of their offspring, and genetic transmission. Communicating the medical risks of pregnancy to women with CKD must be carefully balanced with their values of autonomy, hope, security, and family. Informed and shared decision making that addresses women's priorities as identified in this study may help contribute to improved pregnancy, health, and psychosocial outcomes in this vulnerable population.
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia. Electronic address: allison.tong@sydney.edu.au.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.affiliation: Department of Renal Medicine, St. George Hospital and University of NSW, Kogarah, Sydney, NSW, Australia.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Brown
authors.affiliation: Section of Nephrology, Baylor College of Medicine, Houston, TX.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Centre for Clinical and Experimental Transplantation, Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Shilpanjali
authors.initials: S
authors.lastname: Jesudason
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003469:Culture; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D006435:Renal Dialysis / Q000523:psychology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Shared-decision making; chronic kidney disease (CKD); fetal health; infertility; interview; kidney transplant recipient; maternal health; motherhood; pregnancy; pregnancy complication; qualitative research