Nephrologist Perspectives on Navigating Pregnancy Planning and Care in Women With Kidney Disease: A Qualitative Study

Rationale lack of reliable resources to guide care (absence of guidelines, personal networks as a substitute for formal support); de-prioritised and difficult to discuss (not seen as core nephrology work, oversight amid competing demands, gendered assumptions and clinical discomfort); risk aversion driven by fear of catastrophic outcomes (avoiding disastrous consequences, pregnancy discouraged until post-transplant) and navigating patient autonomy and shared decision making (preference for patients to initiate discussions, need for patient education and support resources, shared decision making as a care principle). Across interviews, transplantation functioned as a clinical threshold and clinicians commonly deferred pregnancy discussions until after a transplant, viewing it as a prerequisite for acceptable maternal and foetal risk. Limitations Findings from the Australian healthcare setting may not be fully transferable to other health systems. Conclusions Nephrologists in Australia face considerable barriers in delivering reproductive care. Despite expressing support for patient autonomy, many clinicians defer or avoid reproductive discussions, especially in women with advanced CKD, limiting informed decision-making. Addressing these barriers through structured training, clear guidelines, and systematic integration of reproductive care into routine nephrology practice is essential to ensuring that women receive timely, equitable, and patient-centred reproductive care. Plain-Language Summary Women with chronic kidney disease face higher risks in pregnancy and often need counselling before conception to understand these risks and plan safely. Nephrologists play an important role in this care, but it is not clear how prepared they feel to provide it. We interviewed 20 nephrologists across Australia to explore their views and experiences. Many described limited training, low confidence, lack of practical guidance, and difficulty finding time to discuss fertility and pregnancy in routine care. Fear of serious maternal and foetal complications often led clinicians to discourage pregnancy, especially before kidney transplantation. Although nephrologists supported shared decision making, many waited for patients to raise the topic first. Better training, clearer guidance, and routine reproductive counselling are needed.