RESUMO
BACKGROUND: Women with chronic kidney disease have an increased risk of maternal and fetal complications in pregnancy. Pre-pregnancy counselling is recommended but the format of the counselling process and the experience of the patient have never been assessed. This study examines the experience of women with chronic kidney disease attending pre-pregnancy counselling and evaluates their pregnancy outcomes. METHODS: This is a cross-sectional assessment of 179 women with chronic kidney disease attending a pre-pregnancy counselling clinic (2003-2011) with retrospective evaluation of aetiology, comorbidity, treatment and adverse pregnancy outcome compared with 277 hospital controls. It includes an analysis of descriptive data and free text content from 72 questionnaire responders. RESULTS: 65/72 (90%) of women found the clinic informative. 66 women (92%) felt that the consultation had helped them decide about pursuing pregnancy. 12 women (17%) found the multidisciplinary process intimidating. Free text comments supported the positive nature of the counselling experience, but also highlighted issues of access and emotional impact. Adverse pregnancy outcome rates were significantly higher in women with chronic kidney disease: 7/35 (20%) had pre-eclampsia (p < 0.001), 8/35 (23%) infants were small for gestational age (p < 0.001), 11/35 (31%) had preterm deliveries (<37 weeks) (p < 0.001) and 5/35 (14%) had a pregnancy loss compared with 4%, 10%, 8% and 3% of controls respectively. CONCLUSIONS: Women with a diverse range of renal disease severity and complexity attend pre-pregnancy counselling. Factors affecting pregnancy include hypertension, proteinuria and teratogenic medication. It is important to be able to inform women of the risks to them and their babies before pregnancy in order to facilitate informed-decision making. Most women with chronic kidney disease attending a pre-pregnancy counselling clinic report a positive experience.
Assuntos
Aconselhamento Diretivo/métodos , Complicações na Gravidez/etiologia , Resultado da Gravidez , Gravidez de Alto Risco , Cuidado Pré-Natal/métodos , Insuficiência Renal Crônica/complicações , Adulto , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Avaliação das Necessidades , Gravidez , Complicações na Gravidez/fisiopatologia , Valores de Referência , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Reino Unido , Adulto JovemAssuntos
Cuidado Pré-Concepcional/organização & administração , Fatores Etários , Consumo de Bebidas Alcoólicas/efeitos adversos , Índice de Massa Corporal , Doença Crônica , Feminino , Nível de Saúde , Humanos , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/efeitos adversos , Fumar/efeitos adversos , Saúde da MulherAssuntos
Transtornos Mentais/epidemiologia , Cuidado Pré-Concepcional/organização & administração , Complicações na Gravidez/epidemiologia , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Feminino , Predisposição Genética para Doença , Humanos , Serviços de Saúde Materna/organização & administração , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/genética , Gravidade do Paciente , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/genética , Recidiva , Fatores de Risco , Fatores SocioeconômicosRESUMO
Because women are becoming pregnant at a later age, hypertension is more commonly encountered in pregnancy. In addition, with increasing numbers of young women living with renal transplants and kidney disease, it is important for physicians to be aware of the effects of pregnancy on these diseases. A multidisciplinary approach is essential to assess and care for pregnant women with kidney disease. Pre-pregnancy counselling should be offered to all women with chronic kidney disease. A review of medication to avoid teratogenicity and optimise the disease prior to conception is the ideal. Pregnancy may be the first medical review for a young woman, who may present with a previously undiagnosed renal problem.
