While it’s possible to live a completely normal life with chronic kidney disease (CKD) in many regards—from work and volunteering to socializing and staying active—the stakes are higher when it comes to CKD and pregnancy. For women with CKD who wish to bear children, it’s normal to be concerned about how kidney disease can affect your health and that of your baby.

Pregnancy with CKD is considered high-risk, but it is possible under physician guidance for some women to have healthy pregnancies. Learn more about CKD and pregnancy, including potential risks and important considerations for those on dialysis.*   

Why is it harder for women to get pregnant on dialysis?

Some studies have shown only 1-7% percent of women of childbearing age on dialysis can get pregnant. 

The most common reasons for this include:

• Decreased ability to produce healthy eggs that can be fertilized, due to CKD
• Irregular menstruation, due to abnormal hormone levels in the body

What are some things to consider before pregnancy?

Some women with CKD are at higher risk for certain complications while pregnant, such as:

• Preeclampsia (pregnancy-related high blood pressure)
• Restricted fetal growth
• Preterm (early) delivery.

This is why it’s important to talk to your doctor before getting pregnant. Your doctor will consider all possibilities based on your unique case and will discuss the potential risks with you.

These risks may include: 

Worsening of CKD for women with moderate to severe CKD, which may warrant dialysis (if not already on it)

• Worsening of existing iron-deficiency anemia
• Reduced vitamin D levels
• Increased blood pressure
• Increased waste products due to poor kidney function, which can be detrimental to the baby

Will more dialysis treatments be needed for pregnant CKD patients?

A pregnant woman may need to increase the frequency of treatment from three to five or six times per week, depending on what the nephrologist suggests. Longer, in-center nocturnal treatments may also be an option if a patient’s schedule does not permit them to receive treatment more frequently during the day. The increased treatment time will help prevent waste build-up and improve blood pressure control. 

Women on peritoneal dialysis (PD) may still receive treatment, but they may experience more abdomen discomfort. This is caused by a build-up of dialysis fluid in the abdomen, along with the baby’s growth in size. Some nephrologists may suggest supplementing with hemodialysis as the due date gets closer to ensure that blood is getting cleaned sufficiently.

Is it safe to get pregnant after a kidney transplant?

Kidney transplants are another form of treatment for late-stage CKD. The likelihood of having a successful pregnancy is much greater post-transplant, as most women typically experience regular periods and better general health. 

It is not recommended to attempt to conceive immediately after a kidney transplant; the standard recommendation is to one until one year after your transplant. In some cases, doctors may even recommend a woman to avoid pregnancy entirely, due to the potential risk to the mother’s life or loss of the kidney transplant. 

What are some ways to promote a healthy pregnancy?

Your doctor can give you specific recommendations, but some general suggestions to help encourage a healthy pregnancy include:

• Have frequent ultrasounds to monitor the baby’s development.
• Receive erythropoietin (EPO) to treat anemia to improve the overall health.
• Regularly see a nephrologist, a dialysis nurse, a pediatrician that specializes in premature births, and a renal dietitian.

Additional information can be found on kidney disease and pregnancy can be found on the UT Southwestern Medical Center website.

*DaVita Kidney Care. (n.d.). Pregnancy and Kidney Dialysis. https://www.davita.com/treatment-services/dialysis/on-dialysis/pregnancy-and-kidney-dialysis