Pregnancy/Pre-Eclampsia

Pregnancy can place a lot of stress on the body and if you have pre-existing kidney disease it is important before starting a family to discuss how your kidney disease may impact your pregnancy. 

Dr Gujadhur is committed to providing compassionate kidney care in pregnancy, providing new mums with reassurance at a time they need it most. 

Here she answers her patient’s most asked questions.

Can women with kidney disease have a baby?

The good news is that many women with mild kidney disease (Stage 1-2) can have a healthy pregnancy. However for women with later State 3-5 Kidney Disease pregnancy presents significant risks and should generally be avoided or discussed carefully with your treating team.

Can I have a baby if I have had a kidney transplant?

For women who have had a kidney transplant, having a baby is still absolutely on the cards, as you will still have regular menstrual periods post-transplantation. 

However, even with stable blood pressure you should not attempt pregnancy for at least a year post-pregnancy.  

For women on dialysis, pregnancy is generally not recommended and considered high risk because high levels of waste make it difficult for the baby to develop. 

For men who are on dialysis or who have had a transplant, routine fertility checkups a year after transplant can help if you have been unsuccessful with fertility. 

Sometimes medications used post transplant can reduce fertility, so if you are on dialysis or have had a transplant speak to Dr Gujadhur about this.

What is Pre-Eclampsia?

• Pre-Eclampsia is a potentially dangerous pregnancy complication that typically starts at 20 weeks of pregnancy and results in very raised blood pressure. 
• It often occurs in women whose blood pressure has previously been normal.
• Untreated, Pre-Eclampsia can be fatal for both baby and mother (think Lady Sybil in this  famous episode of Downton Abbey). 
• Complications include fetal growth restriction, preterm birth, placental abruption (where the placenta separates from uterus before delivery which can be life-threatening for Mum and baby).
• Seizures are another symptom along with HELLP Syndrome, (Hemolysis or red blood cell destruction) Elevated Liver Enzymes and Low Platelet Count. This is a very serious form of Pre-Eclampsia and can damage multiple organ systems. 
• Certain conditions before pregnancy place women at greater risk of Pre-Eclampsia, including Hypertension (high blood pressure), Migraine, Type 1 or Type 2 Diabetes, Kidney Disease, Blood Clots or Lupus. 
• IVF also increases the risk of Pre-Eclampsia.
• Other risk factors include age (the condition is higher in very young women and women over 35. 
• Black women also have a higher risk, while having twins, triplets or other multiple births increases the risk, as does having more than 10 years between pregnancies or less than two years. 
• Pre-Eclampsia can also increase your risk of future heart disease, especially if you’ve had the condition more than once.  
• If this is your first pregnancy especially, it is very important to report any symptoms you are concerned about to your doctor immediately.

What are the symptoms of Pre-Eclampsia?

• Quite often there are no symptoms of Pre-Eclampsia but high blood pressure and protein in the urine are key features along with leg swelling. However it is often difficult to differentiate between swelling that is not quite normal and the common garden variety of leg swelling that is also very common in pregnancy, so best tell your doctor about any swelling.   
• Other symptoms may include high blood pressure, fatigue, shortness of breath, upper abdominal pain, decreased urine output, impaired liver function, severe headache, nausea or weight gain.
• Preeclampsia can come on suddenly in a matter of hours, with signs and symptoms undetected for weeks. 
• Slow growth in the baby is another sign as the condition impacts the arteries carrying blood to the placenta.

What is the treatment for Pre-Eclampsia?

• The best treatment for Pre-Eclampsia is delivery, however if it’s early in the pregnancy delivery may not be ideal for your baby. 
• If you have been diagnosed with Pre-Eclampsia, you may require more frequent prenatal visits with your obstetrician and Dr Gujadhur. You’ll  also need frequent blood test monitoring, ultrasound, and other tests to measure your baby’s breathing, muscle tone and volume of amniotic fluid. 
• Medications will help keep blood pressure at a safe level, however some blood pressure medications are not safe in pregnancy, so this needs to be discussed with your doctor. 
• Blood pressure in the 140/90 (mmHG) or lower is generally not treated with medication. 
• Corticosteroids and anticonvulsant medications to prevent seizures may also be prescribed. 
• Bed rest and wrapping yourself in cotton wool is no longer recommended; in fact gentle exercise is good for Preeclampsia. 
• Your doctor may induce labour right away in severe cases or schedule a C-section, and some severe cases may require hospitalisation. 
• Whilst mortality is still 14% in developing countries, in the overwhelming majority of cases in Australia, Preeclampsia rarely results in serious consequences for Mum or baby when it is carefully managed.