Pregnancy should not be advised against women with chronic kidney disease or a kidney transplant by default, despite the increased risks. Personal and multidisciplinary counselling is crucial here. That is the main conclusion of gynaecologist in training Margriet Gosselink (Genetics and Woman & Baby department, UMC Utrecht), who obtained her PhD on 15th of April.
The aim of her research was to improve care for women with kidney disease and a pregnancy wish, partly by gaining more insight into kidney disease-specific pregnancy outcomes for the mother, child and kidney function.
Chronic kidney disease and pregnancy are not a rare combination. In the Netherlands, about 4.5% of women aged 20 to 44 years have some form of chronic kidney disease. Of those who develop kidney failure before the age of 50, about 20% have hereditary kidney disease. Many of these women, and their partners, have questions about pregnancy: What does it mean for their own health? What are the risks to their baby? And how likely are they to pass on the disease?
During pregnancy, significant changes occur in the mother’s circulatory system. Due to increase in the pumping function of the heart, decrease in blood pressure and increase in the amount of blood, the filtering function of the kidney increases by up to 50%. However, the kidneys of women with kidney disease have fewer reserves to adapt to these changes required for a healthy pregnancy. Pregnancy in women with kidney disease therefore carries increased risks, such as high blood pressure, preeclampsia and preterm birth.
Gosselink’s thesis shows that pregnancy is often possible even after kidney transplantation. The better the kidney function before pregnancy, the better the outcomes for mother and child. Furthermore, it turns out that understanding pregnancy outcomes for specific kidney diseases – especially even down to the exact hereditary type, such as in Alport syndrome that Gosselink specifically studied, – helps in predicting risks more accurately and providing better guidance to women.
Both men and women with hereditary kidney disease should be well informed about their options when desiring children. Think preconception advice, about risks in pregnancy, the role of heredity, and options such as embryo selection (PGT) to prevent inheritance, as well as care for children who may have the predisposition; topics that Margriet studied specifically in patients with cyst kidneys (ADPKD). The timely and personalised information provided by expert teams in this field, in which nephrologists, gynaecologists, clinical geneticists and paediatric nephrologists work together, helps patients and their partners to make informed decisions.
Finally, this thesis provides recommendations to improve access to genetic diagnostics and care across Europe, so that people with hereditary kidney disease get the right care and information regardless of where they live.
The centre of expertise for hereditary a congenital kidney and urinary tract disease (website in Dutch) is committed to providing the best possible support for women with kidney disease and their partners in their desire to have children through research such as this.
