Women with chronic kidney disease attending pre-pregnancy counselling experienced significantly higher rates of pre-eclampsia (20% vs 4%) compared to hospital controls.
Cross-Sectional (n=456)
No
Does multidisciplinary pre-pregnancy counselling provide a positive patient experience, and what are the pregnancy outcomes in women with chronic kidney disease compared to controls?
Multidisciplinary pre-pregnancy counselling is well-received by women with CKD, who remain at significantly higher risk for adverse pregnancy outcomes compared to controls.
Absolute Event Rate: 20% vs 4%
p-value: p=<0.001
BACKGROUND: Women with chronic kidney disease have an increased risk of maternal and fetal complications in pregnancy. Pre-pregnancy counselling is recommended but the format of the counselling process and the experience of the patient have never been assessed. This study examines the experience of women with chronic kidney disease attending pre-pregnancy counselling and evaluates their pregnancy outcomes. METHODS: This is a cross-sectional assessment of 179 women with chronic kidney disease attending a pre-pregnancy counselling clinic (2003-2011) with retrospective evaluation of aetiology, comorbidity, treatment and adverse pregnancy outcome compared with 277 hospital controls. It includes an analysis of descriptive data and free text content from 72 questionnaire responders. RESULTS: 65/72 (90%) of women found the clinic informative. 66 women (92%) felt that the consultation had helped them decide about pursuing pregnancy. 12 women (17%) found the multidisciplinary process intimidating. Free text comments supported the positive nature of the counselling experience, but also highlighted issues of access and emotional impact. Adverse pregnancy outcome rates were significantly higher in women with chronic kidney disease: 7/35 (20%) had pre-eclampsia (p < 0.001), 8/35 (23%) infants were small for gestational age (p < 0.001), 11/35 (31%) had preterm deliveries (<37 weeks) (p < 0.001) and 5/35 (14%) had a pregnancy loss compared with 4%, 10%, 8% and 3% of controls respectively. CONCLUSIONS: Women with a diverse range of renal disease severity and complexity attend pre-pregnancy counselling. Factors affecting pregnancy include hypertension, proteinuria and teratogenic medication. It is important to be able to inform women of the risks to them and their babies before pregnancy in order to facilitate informed-decision making. Most women with chronic kidney disease attending a pre-pregnancy counselling clinic report a positive experience.
Wiles et al. (Fri,) conducted a cross-sectional in Chronic kidney disease in pregnancy (n=456). Pre-pregnancy counselling for chronic kidney disease vs. Hospital controls without pre-existing renal disease, hypertension, or diabetes was evaluated on Pre-eclampsia (p=<0.001). Women with chronic kidney disease attending pre-pregnancy counselling experienced significantly higher rates of pre-eclampsia (20% vs 4%) compared to hospital controls.