Pregnancy and Kidney Disease
Pregnancy in women with kidney disease or renal failure is an infrequent occurrence. Generally, more severe kidney dysfunction along with a higher number of associated comorbidities, means it is more likely that a woman’s fertility will be impaired and that an ensuing pregnancy will be more complicated (Piccoli et al., 2010a; Vidaeff et al., 2008). It is estimated that the pregnancy rate of women of childbearing age with renal disease ranges from 0.03% to 7% (Fink et al., 1998; Holley and Reddy, 2003), which is well below the estimated pregnancy rate of 10.3% in the general U.S. population (CDC, 2009). Causes for the reduction in pregnancy rates in women with renal disease are not completely understood; however, it is known that there is a marked reduction in presence of menses and/or ovulation in women undergoing dialysis (Holley et al., 1997; Piccoli et al., 2010b). Once pregnancy has begun, it is considered to be high risk and requires complex and intensive management by the health-care team (Figure 12.1).