Kidney disease and pregnancy: a new era?

Published on September 26, 2018   41 min

Other Talks in the Series: The Kidney in Health and Disease

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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".
I have no disclosures.
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.
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.
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.