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Printable Handouts
Navigable Slide Index
- Introduction
- Disclosures
- Objectives
- Changes in clinician practice
- What are women feeling?
- Objectives
- Increase in number of report pregnancies on dialysis
- Optimisation: pre-pregnancy counselling
- Which women with CKD should receive PPC?
- Pre-pregnancy counselling - CKD stage1
- Case 1: timing of conception
- Pregnancy outcomes in women with CKD
- Case 1: Timing of conception
- Case 2: Timing of conception
- Disease activity
- Quiescent lupus
- Neonatal syndromes
- Lupus nephritis – pre-pregnancy counselling
- Case 2: disease activity
- Lupus nephritis – outcomes
- Tacrolimus in lupus pregnancy
- Lupus pregnancy
- Case 3
- Diabetic nephropathy and pregnancy
- HbA1C and fetal malformations
- Neonatal outcomes
- Diabetic nephropathy pregnancy outcomes
- All cause CKD vs. diabetic nephropathy
- ACE inhibitors/ARBs
- Systematic review of ACEI/ARB exposure
- First trimester ACEI exposure
- ACE inhibitor and congenital abnormalities
- Continuing RAAS blockade pre-conception
- Progression of proteinuria
- Does pre-pregnancy RAAS blockade help?
- RAAS blockade pre-conception conclusion
- Case 3: treatment
- Timing of conception – ovarian reserve
- Anti-mullerian hormone
- Anti-mullerian hormone in women with CKD
- Case 1
- Pre-implantation genetic diagnosis
- Assisted conception in CKD
- Mechanisms of reduced fertility in advanced CKD
- Consequences of CKD Stage 5
- Fertility and treatment
- CKD stage 4/5
- Pregnancy and dialysis history
- Dialysis and pregnancy review
- The Toronto experience
- Effect of dialysis intensity on pregnancy
- Fetal mortality
- Meta-analysis 681 pregnancies in 647 women
- Unknowns in haemodialysis and pregnancy
- Peritoneal dialysis
- What are the consequences for the offspring?
- What are the consequences for the mother?
- Antenatal surveillance
- First trimester screening for trisomy
- Antenatal surveillance - placental biomarkers
- Placental growth factor (PlGF)
- Placental growth factor: longitudinal changes
- Case 4
- Case 4: outcomes
- Increasing use in clinical practice
- Doppler studies
- Doppler in women with CKD
- Neonatal outcomes
- Neonatal outcomes progression
- Perinatal death for women with CKD
- Effect of gestation at delivery on the neonatal
- Lupus pregnancy patient letter
- Prescribing in pregnancy
- Increasingly complex patients
- Conclusions
- Thank you
Topics Covered
- Pre-pregnancy planning and fertility in women with CKD
- Pregnancy in women with pre-existing chronic kidney disease (CKD) including dialysis, renal transplant, diabetic nephropathy and lupus nephritis
- Diagnosis and management of superimposed pre-eclampsia in women with CKD
- Clinical cases and outcomes of pregnant women with CKD
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Bramham, K. (2018, September 26). Kidney disease and pregnancy: a new era? [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 7, 2024, from https://doi.org/10.69645/QHVV1390.Export Citation (RIS)
Publication History
Financial Disclosures
- Dr. Kate Bramham has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
Other Talks in the Series: The Kidney in Health and Disease
Transcript
Please wait while the transcript is being prepared...
0:00
My name's Kate Bramham. I'm a Consultant Nephrologist at King's College Hospital,
and I'd like to talk about "Kidney Disease and Pregnancy: a New Era".
0:11
I have no disclosures.
0:14
So the objectives of the talk, today,
are to get a better understanding of how we use pre-pregnancy counseling in women who
got chronic kidney disease and an important part of
that counseling process is to be able to assess their fertility.
We're also going to talk about how we can
optimize pregnancy outcomes for women with chronic kidney disease,
and also briefly right at the end of the talk,
just to touch upon some of the drugs that we use in pregnancy because that
often cause a lot of anxiety for healthcare professionals.
0:46
So there's been a dramatic change in the management of patients
who have chronic kidney disease and particularly with their attitude towards pregnancy.
Historically, a lot of women have been told that they shouldn't conceive because of
the likely poor outcome for their offspring but
also because of the risk of progression of their kidney disease.
Unfortunately, that's didactic practice
that happened in the past has caused a lot of harm to
our women's perception of their approach to pregnancy
and I think that now things are starting to change certainly in the modern day.
1:22
This is a very helpful review of
16 studies that was published by Allison Tong a couple of years ago.
She looked at all the studies that were reporting women's approach to pregnancy,
and it was very insightful in this it demonstrated
that women who got chronic kidney disease were extremely into
'pursuing motherhood' but there was a lot of
associated psychological impact for women
who were unable to particularly within different cultures,
some women described a devastating loss after being denied
their motherhood and they were very upset about the approach that
clinicians took in terms of being very
prescriptive about telling them not to have
pregnancy rather than giving them an informed choice.
So this is something that we are desperately trying to change and
that's definitely in our pre-pregnancy counseling service.
We would barely ever tell someone to stop,
never to consider a pregnancy,
but we would give them
very detailed information so that they can make that choice themselves.