Pregnancy and kidney disease: Overcoming the challenge

New Delhi: Getting pregnant and starting a family are great experiences but may present challenges even for a normal healthy human being.

However, such challenges become manifold when it comes to female patients with certain health conditions, such as, chronic kidney disease (CKD).

"CKD is a serious ailment affecting about 10% of the global population with women being more prone to the condition than men. It affects about 195 million women globally each year and is responsible for 6 lakh fatalities every year, making it the 8th leading cause of death in them," said Dr Hrishikesh D Pai, Medical Director, Bloom IVF Group.

A common complication in women with CKD is difficulty in conceiving with the chances of pregnancy reducing as the condition advances. Apart from this, pregnancy in women with CKD is considered high risk due to an increased likelihood of complications in both the mother and the fetus.

Such women stand the risk of premature delivery, still births, and intrauterine growth restriction. In women with both CKD and preeclampsia, the outcomes can get worse. All this, coupled with a lack of awareness and knowledge about this condition and the absence of standard care in many regions of the country, paint a grim picture.

-Stages of CKD and pregnancy

Stages 1-2 are termed as mild CKD. Women with mild CKD with normal blood pressure and no or very little protein in urine can have healthy full-term babies. Stages 3-5 of CKD are considered moderate to severe and can present more serious complications. In such cases, both the mother and the developing baby are at greater risk.

Such women are often advised to avoid pregnancy until later when their disease is under control. Women with severe CKD may require regular dialysis. This may result in them suffering from severe anemia and hormonal imbalance which may affect their menstrual cycle.

"Fertility is restored in patients who have had kidney transplant and women return to their normal reproductive cycle within a few months. However, they are advised to wait for at least a year before trying to conceive. Some medications prescribed post-transplant can also affect fetal development. Therefore, it is advised to speak to your doctor if you have undergone kidney transplant and are thinking of pregnancy," added Pai.

-Assisted reproductive techniques and CKD

Despite these complications, advances in medical science and technology, in the form of assisted reproductive techniques (ARTs) have ensured that women with CKD can also conceive and has given a ray of hope to them.

ART and hormone therapy which works through a combination of medicines and hormone treatment has shown to be a promising option for women with CKD who develop fertility problems. Women with mild CKD can opt to preserve their eggs with the help of cryopreservation for conception at a later stage. It can prove beneficial especially in those women who may completely lose their fertility due to progressive kidney disease.

In-Vitro Fertilization (IVF) techniques are helpful in patients with CKD as the egg and the sperm are fertilized outside the body and the resulting embryo is then placed in the uterus.

Treatment with gonadotropins can be useful in women with loss of fertility due to dialysis once the kidney disease is under control.

"It is imperative to be aware of and understand the risks and the complications involved if you opt for conception with CKD. While kidney disease may adversely affect your chances of conceiving and taking your pregnancy through to a healthy outcome, ARTs are here to help. Discuss with your nephrologist, gynecologist, and fertility expert to understand the choices you have," concluded Pai.