Outcomes of and perspectives on pregnancy counseling among kidney transplant recipients

Patient and Partner Perspectives of Pregnancy-Related Counseling and Information Needs in Women With Kidney Disease: An Australian National Survey

Introduction

The experiences and information needs for reproductive health counseling in women with chronic kidney disease (CKD) are poorly defined, despite the known importance of pregnancy planning in this higher-risk cohort.

Methods

Australian adult women with CKD and their partners or family members completed a consumer codesigned survey about experiences of and preferences for pregnancy-related counseling, support, and education. Data were analyzed descriptively and with qualitative content analysis of free-text responses.

Results

Responses were received from 102 women (CKD, n = 60; dialysis, n = 11; transplant, n = 26; unsure, n = 5 ) and 17 partners/family members. Pregnancy-related discussions were initiated mostly by women themselves (60.0%) compared to nephrologists (26.7%), and only after conception in 14.7%. Women found pregnancy-related discussions satisfactory (68.0%) and useful (50.7%) but also stressful (66.7%), with only 54.7% feeling in control of decision-making. Information deficits and quality, preformed decisions, clinician-patient disconnect, and burden of decision-making contributed to usefulness and outcomes of pregnancy-related counseling. Women received insufficient information about contraception (not provided in 35.2% of cases), medication safety (40.9%), fetal complications (33.8%) and emotional and psychological impact of pregnancy (73.2%). Women preferred counseling from nephrologists (86.4%), face-to-face settings (79.6%), websites (72.7%), handouts (61.4%), and online support groups (46.6%). High-quality, multiformat information by content experts, peer support, and psychological support were also strongly desired.

Conclusion

This study highlights that preconception counseling and information needs of women with CKD are currently not being met. Frameworks and tools to assist patients and clinicians, particularly nephrologists, to initiate and conduct sensitive, useful, and informed shared decision-making (SDM) about pregnancy are urgently needed.

[Pregnancies after kidney transplant: What are the consequences for the cognitive development of children?]

Thanks to medical progress in the field of kidney transplantation, the quality of life of women suffering from kidney failure has greatly improved in recent years. As a result, their fertility has increased significantly and pregnancies are now more frequent and safer. Kidney transplantation requires constant immunosuppressive treatment during pregnancy. These products can cross the placental barrier and their prescription is therefore subject to rigorous medical monitoring. There are many environmental factors that can affect the development of the child during pregnancy and affect its subsequent cognitive development. The possible impact of these immunosuppressive treatments on the medium- and long-term intellectual development of the children concerned is as yet little documented. Even if the available data are reassuring, the methodologies used in this work nevertheless raise questions and legitimize the development of complementary research. The aim of this review is to propose a synthesis of existing data in this field and to open up avenues for future research.