Reproductive counseling low in women with kidney disease despite maternal, fetal risks
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Among 125 women with kidney disease who were of childbearing age, less than two-thirds received reproductive health counseling from their nephrologist, according to a retrospective chart review.
This was true despite that 75.2% were taking potentially teratogenic medicines at the time of their most recent clinic visit, Ivie O. Okundaye, MD, of Stanford University & Hospitals in Palo Alto, California, and colleagues found, writing: “Given the importance of empowering women to make key health decisions, these results are sobering.”
Pregnancy risks for women with kidney disease
Chronic kidney disease can lead to significant risks for both the mother and the fetus, according to Okundaye and colleagues. Maternal risks include accelerated hypertension, kidney disease progression, premature initiation of dialysis and preeclampsia, while fetal risks include intrauterine growth restriction, preterm delivery, small for gestational age, spontaneous abortion or perinatal death.
“Risks increase with more advanced kidney disease, hypertension, or proteinuria, and medications used to treat CKD are often contraindicated in pregnancy,” the researchers wrote. “Management of blood pressure, proteinuria and disease flares are key interventions that influence maternal and fetal outcomes. Thus, nephrologists play a central role in communicating with women regarding obstetric risks and preventing ill-timed pregnancies.”
For the study, researchers identified women aged 18 to 44 years with CKD who had at least one nephrology clinic outpatient encounter in 2018 or 2019, considering provider documentation of current method of contraception and documentation of reproductive counseling (the mean number of clinic visits was 11; the mean duration of clinical attendance was 3.8 years; 28.8% were documented as currently using contraception).
Reproductive health counseling
Complete reproductive counseling consisted of discussions on the following four areas of interest: contraception (current method and risks); avoidance of pregnancy if teratogenic agents were prescribed; current family planning desires; and maternal and fetal risks of pregnancy. The degree of reproductive counseling was categorized as none, intermediate (defined as meeting one or two of the above measures) or comprehensive (defined as meeting at least three of the above measures).
Findings revealed 24% of women had documentation of comprehensive counseling, 35% had documentation of intermediate counseling and 41% had no documentation of reproductive counseling.
Reproductive health counseling was documented more frequently for women who attended five or more visits, as well as those with longer duration of clinic care.
Women on dialysis had no documentation of comprehensive counseling.
“Complexity of advanced kidney disease care and insufficient time to address multiple health problems at a single visit may have also contributed to low documentation rates. However, women with kidney failure can and do become pregnant, with U.S. registry data reporting many pregnancies annually; thus, these women should not be deprived of reproductive counseling that might prevent ill-timed or unwanted pregnancy,” Okundaye and colleagues wrote, concluding that the study “identifies a large unmet need in nephrology practice.”
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