title: Pregnancy across the spectrum of chronic kidney disease.
abstract: Management of the pregnant woman with chronic kidney disease is difficult for both nephrologists and obstetricians. Prepregnancy counselling with respect to risk stratification, optimization of maternal health prior to pregnancy, as well as management of the many potential pregnancy-associated complications in this complex patient population remains challenging due to the paucity of large, well-designed clinical studies. Furthermore, the heterogeneity of disease and the relative infrequency of pregnancy, particularly in more advanced stages of chronic kidney disease, leaves many clinicians feeling ill prepared to manage these pregnancies. As such, counselling is imprecise and management varies substantially across centers. All pregnancies in women with chronic kidney disease can benefit from a collaborative multidisciplinary approach with a team that consists of nephrologists experienced in the management of kidney disease in pregnancy, maternal-fetal medicine specialists, high-risk pregnancy nursing staff, dieticians, and pharmacists. Further access to skilled neonatologists and neonatal intensive care unit support is essential given the risks for preterm delivery in this patient population. The goal of this paper is to highlight some of the data that currently exist in the literature, provide management strategies for the practicing nephrologist at all stages of chronic kidney disease, and explore some of the knowledge gaps where future multinational collaborative research efforts should concentrate to improve pregnancy outcomes in women with kidney disease across the globe.
authors.affiliation: Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: michelle.hladunewich@sunnybrook.ca.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Hladunewich
authors.affiliation: Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nir
authors.initials: N
authors.lastname: Melamed
authors.affiliation: Division of Transplantation, Immunology and Mucosal Biology, Department of Renal Medicine, King's College, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Bramham
mesh_terms: D003376:Counseling; D018450:Disease Progression; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D033183:Interdisciplinary Communication; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011256:Pregnancy Outcome; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: chronic kidney disease; counselling; pregnancy