Pregnancy and Kidney Disease

A new baby is a joy for any family. But pregnancy can put a lot of stress on your body. If you have kidney disease or kidney failure, it can put you and the health of your unborn child at risk.

Are you thinking about pregnancy? If so, you should discuss it beforehand with your doctor or other healthcare provider. They know you, and they can help you make a decision that is based on your own personal health. There are many things to consider. You and your doctor should discuss them all very carefully. Some things that can affect a healthy pregnancy include:

• Your stage of kidney disease
• Your general health
• Your age
• Having high blood pressure, diabetes, or heart disease
• Having other serious health conditions
• Protein in your urine

Here are a few brief answers to some common questions about kidney disease and pregnancy.

Can a woman with "mild" kidney disease have a baby?

That depends. There is good evidence to suggest that women with very mild kidney disease (stages 1-2), normal blood pressure, and little or no protein in the urine (called "proteinuria") can have a healthy pregnancy. What is proteinuria? It's a sign of kidney damage. Your body needs protein. But it should be in your blood, not your urine. Having protein in your urine usually means that your kidneys cannot filter your blood well and the protein is leaking out.

In women with moderate to severe kidney disease (stages 3-5), the risk of complications is much greater. For some women, the risk to mother and child is high enough that they should consider avoiding pregnancy.

If you are thinking of becoming pregnant, ask your doctor or other healthcare provider about your stage of kidney disease, your risk for complications, your degree of proteinuria, and any other health conditions you may have.

Can a woman who is on dialysis have a baby?

Some changes in your body make it hard to become pregnant. For example, most women on dialysis have anemia (a low red blood cell count) and hormone changes. This may keep them from having regular menstrual periods.

Women with kidney failure are usually advised against becoming pregnant. The rate of complications is very high. Risks to both the mother and developing baby are high. If you are thinking of becoming pregnant, talk to your healthcare provider. If you become pregnant, you will need close medical supervision, changes in medicine, and more dialysis to have a healthy baby.

Can a woman who has a kidney transplant have a baby?

Yes. If you have a kidney transplant, you are likely to have regular menstrual periods and good general health. Therefore, getting pregnant and having a child is possible. But you should not become pregnant for at least one year after your transplant, even with stable kidney function. Some medicines that you take after a kidney transplant can cause problems to a developing baby. In some cases, pregnancy may not be recommended because there is a high risk to you or the baby. Another reason is if there is a risk of losing the transplant.

Talk with your healthcare provider if you have a transplant and are thinking about getting pregnant. Your healthcare provider may need to change your medications so that it is safe for you to become pregnant. It is very important to use birth control until you and your healthcare provider have agreed that it is safe for you to become pregnant.

How might medicines taken by transplant patients affect an unborn child?

Many anti-rejection medicines are generally safe for a pregnant woman and her baby. However, there are some types that can affect pregnancy and the baby. These types should be avoided during pregnancy and stopped at least six weeks (or more) before becoming pregnant. Your doctor will likely monitor you after you've stopped, and let you know when it's safe to attempt pregnancy.

If you have a kidney transplant and are considering pregnancy, you should discuss it carefully with your transplant team and your kidney doctor. Your doctor may want you to switch to a different anti-rejection medicine.

Can a man who is on dialysis or who has a kidney transplant father a child?

Yes. Men on dialysis or those who have a kidney transplant can father children. If you've been trying to father a child for a year or more without success, talk with your doctor. A man with kidney disease or kidney failure may be helped with a routine fertility checkup. Also, some medications that are used after a transplant can reduce a man's ability to father children. If you have a transplant and would like to father a child, talk with your doctor about your mediations.

What kind of birth control is recommended for kidney patients?

Dialysis and transplant patients who are sexually active and have not undergone menopause should use birth control to prevent pregnancy. Your healthcare provider can recommend the type of birth control that should be used. Many women who have high blood pressure should not use "the pill" (oral contraceptives) since this type of medicine can raise blood pressure and increase the chance of blood clots. The diaphragm, sponge, and condom are usually acceptable means of birth control, especially when used with spermicidal creams, foams or jellies. The newer IUD is also possible.

To contact the National Transplantation Pregnancy Registry (NTPR), call toll-free at 1-877-955-6877 or email ntpr@giftoflifeinstitute.org. The National Transplantation Pregnancy Registry (NTPR) has been studying pregnancy in transplant recipients since 1991. You can fill out a one-page questionnaire about your post-transplant pregnancy. The information collected has helped countless transplant recipients make family planning decisions.