Perspectives on pregnancy in women with chronic kidney disease: systematic review of qualitative studies

Abstract

For women with CKD, pregnancy decisions can be emotionally complicated by health risks, family burden and the perceived risk of fetal malformation. Proactive counseling, shared decision-making about family planning and managing pregnancy in CKD that addresses patient preferences, and multidisciplinary care involving nephrologists, reproductive and obstetrics specialists, and psychological support may improve management of pregnancy issues in CKD.

Perspectives on Pregnancy in Women With CKD: A Semistructured Interview Study

“…The purposive sampling strategy was successful in recruiting a large number of women with a range of demographic characteristics and experiences of CKD. Participants were recruited from 2 units in Australia, although similar themes identified in studies conducted in other settings 16 suggest broad applicability of the findings. Non-English-speaking participants were excluded, although women from different ethnic minority groups were included.…”

“…16 A.T. conducted semistructured interviews from August to October 2014, and recruitment ceased when no new concepts were raised after 3 consecutive interviews (theoretical saturation). All interviews were digitally recorded and transcribed.…”

“…15,16 Counseling without explicit consideration of women's values can be distressing and impede shared decision making. Despite this, our recent systematic review of women's perspectives of pregnancy in CKD identified only a few primary studies and a limited number of themes relating to achieving motherhood, decisional insecurities and conflicts, fears for maternal and fetal health, and control and autonomy.…”

“…Despite this, our recent systematic review of women's perspectives of pregnancy in CKD identified only a few primary studies and a limited number of themes relating to achieving motherhood, decisional insecurities and conflicts, fears for maternal and fetal health, and control and autonomy. 16 The aim of this study is to describe women's beliefs and experiences of pregnancy in CKD, which can be addressed in prepregnancy counseling and management of pregnancy in these high-risk patients to improve health, pregnancy, and psychosocial outcomes.…”

The Spectrum of Adverse Pregnancy Outcomes Based on Kidney Disease Diagnoses: A 20-Year Population Study

“…Appreciation of these risks will facilitate early referral and optimize medical management during the antenatal period [14]. Motherhood has been identified as a priority for women with kidney disease [15,16], and providing evidencebased assessment of risks and strategies to mitigate these risks assists in promoting collaborative, patient-centered care.…”