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Estimating the need for prepregnancy care in women with chronic kidney disease (CKD)
  1. L A Baines,
  2. M C Smith,
  3. J M Davison,
  4. J J S Waugh
  1. NUTH NHS Foundation Trust, Newcastle upon Tyne, UK

Abstract

Introduction For women with chronic kidney disease (CKD), appropriate contraception and prepregnancy counselling is recommended to minimise pregnancy risk and the impact of pregnancy on their disease.

Aim A pilot study to determine the advice received by women with CKD on contraception, pregnancy and prepregnancy care in nephrology out-patients.

Method Questionnaires were given to women between 18 and 45 years attending renal clinics. Additional data recorded included age, kidney disease, hypertension, serum creatinine, estimated glomerular filtration rate (eGFR), proteinuria and current medicines.

Results 31 women completed questionnaires (100%). Mean age 34 years (range 20–47). Kidney diseases included glomerulonephritis, vasculitis, polycystic kidney disease, Alport's syndrome and diabetes. 15 women were hypertensive and fifteen proteinuric. 19 women had normal eGFRs.

29% of women reported an unplanned pregnancy and 39% pregnancy related problems. Only 48% and 35% of women had discussed contraception and pregnancy, respectively. 45% of women were unaware of pregnancy risks related to CKD and 39% unaware of potentially teratogenic medicines.

23% and 29% of women reported receiving advice specifically related to their CKD and medicines respectively. 80% of women considered contraceptive advice to be at least adequate. 53% of women were using contraception, (condoms in 30%).

Conclusion There is a need for improvement to ensure that all women with CKD receive appropriate advice on contraception and family planning. This could be commissioned through a combined obstetric nephrology service where appropriate but should also be part of routine nephrology care.

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