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Kidney Disorders During Pregnancy

By Lara A. Friel, MD, PhD, University of Texas Health--Medical School at Houston

Women with a severe kidney disorder before pregnancy are more likely to have problems during pregnancy. The fetus may not grow as much as expected or may be stillborn.

If pregnant women have a kidney disorder, they are more likely to develop high blood pressure, including preeclampsia (a type of high blood pressure that develops during pregnancy). If pregnant women have high blood pressure that is not well-controlled—whether it was present before they become pregnant or develops during pregnancy—they are more like to develop a kidney disorder. Kidney function may rapidly worsen during pregnancy.

In pregnant women who have a kidney disorder, kidney function and blood pressure are monitored closely, as is growth of the fetus. Often, the baby must be delivered early. If the kidney disorder is severe, women may need to be hospitalized after 28 weeks of pregnancy so that bed rest is guaranteed, blood pressure can be controlled well, and the fetus can be monitored closely.

Women who have had a kidney transplant are usually able to safely give birth to healthy babies if they have all of the following:

  • A transplant that has been in place for 2 or more years

  • Normal kidney function

  • No episodes of rejection

  • Normal blood pressure

Women who have a kidney disorder that regularly requires hemodialysis are often at high risk of pregnancy complications, including miscarriage, stillbirth, preterm birth, and preeclampsia. But because of advances in dialysis treatment, up to 90% of babies born to these women survive.

Usually, delivery is required before the due date because the woman develops preeclampsia or the fetus is not growing as much as expected. Doctors may remove and analyze a sample of the fluid that surrounds the fetus (amniotic fluid). This procedure, called amniocentesis, helps doctors determine whether the fetus’s lungs are mature enough to breathe air and thus when the baby can be delivered safely.

Cesarean delivery is often done, but sometimes vaginal delivery is possible.

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