For women with chronic kidney disease (CKD), healthy pregnancies can be very difficult. Some doctors may even encourage their patients to avoid getting pregnant because of the risks to both patient and baby. Other doctors may recommend strategically planning a pregnancy for maternal optimization. 

In both scenarios, contraception in CKD may be important to avoid a dangerous pregnancy. Discover more about the concerns for pregnancy in CKD and the pros and cons of available contraceptives.* 

What risks may occur when getting pregnant or during pregnancy?

The medications you are currently taking and your stage of CKD will determine the degree of risk associated with getting pregnant. 

The following are potential reasons why pregnancy in CKD may be dangerous:

• Some commonly prescribed medications, like ACE inhibitors, are teratogenic, i.e., disturb the development of an embryo or fetus.
• Increased risk for a flare-up or an acute kidney injury (AKI)
• Higher risk for worsening of CKD, where dialysis may be required
• Significant potential for preeclampsia, prematurity, and poor fetal growth
• Higher risk for future vascular disease for both mother and baby

What types of contraception are safe for women with CKD?

Since there are multiple types of contraception, it is important to discuss with an experienced and trusted doctor before starting one. There are six common types of contraception, some of which are better suited for women with CKD than others:

1. For individuals who do not plan to have children, sterilization of either the female or male partner is a permanent option with a very low failure rate. 
2. An option for women who do not plan to become pregnant soon is progesterone injections, as it may take up to 18 months to restore fertility after stopping the injections. The main concern with this option is a decrease in bone mineral density and increased risk for venous thromboembolism (VTE).
3. Available as a pill, vaginal ring, or patch, estrogen/progestin combination contraception may be the highest risk for CKD patients—and even contraindicated in some patients. This contraception may cause an increased risk for myocardial infarction and stroke. Moreover, it could worsen blood pressure and proteinuria in CKD patients.
4. Progesterone-only pills do not cause an increased risk for VTE but must be taken consistently every day within a 3-hour window. 
5. A barrier method, like a condom, may help prevent the risk of sexually transmitted disease (STD). Unfortunately, it does have a higher failure rate than other contraceptives.
6. Progestin-impregnated intrauterine devices (IUDs) and progestin-only pills may be a safer option for many CKD patients, as there is not an increased risk for VTE, high blood pressure, or worsening proteinuria.
7. Natural family planning methods allow women to estimate peak fertility and, therefore, avoid sexual intercourse. This method has varying degrees of effectiveness, with reported failures being related to improper application of these methods. 

It is your right as a woman to decide freely and responsibly whether or not your wish to get pregnant, as well as the number, timing, and spacing of your children if you choose to do so. A doctor can recommend what may be the safest and most effective option for you as a CKD patient, but it is important to take time to consider what is best for your lifestyle and personal preference. 

*Burgner, A., & Hladunewich, M. A. (2020, Apr.). Contraception and CKD. Clinical Journal of the American Society of Nephrology. https://cjasn.asnjournals.org/content/15/4/563