Service

General

1. Multidisciplinary clinics should be established to assess and care for pregnant women with kidney disease. including those women receiving dialysis and kidney transplant recipients.

2. Named experts, forming a multidisciplinary team (MDT), with appropriate facilities, need to be available to manage or advise on all women with kidney disease in pregnancy.

3. The MDT requires, as a minimum, an obstetrician, a renal/obstetric physician and a specialist midwife, all with expertise in the management of kidney disease in pregnancy.

Prepregnancy

4. Women of childbearing age with kidney disease should be made aware of the implications regarding reproductive health and contraception.

5. Women with kidney disease considering pregnancy should be offered prepregnancy counselling by the MDT. This active preparation for pregnancy should be individualised to each woman's needs and should involve her partner.

6. Prepregnancy counselling should allow discussion of and, where possible, modification of remediable risk factors, including consideration of familial conditions and optimisation of medications.

7. Women with kidney disease considering in vitro fertilisation (IVF)/assisted reproduction should be referred for prepregnancy counselling to the MDT. Strong consideration should be given to recommending single-embryo transfer if IVF is required.

8. Women with normal or only mildly decreased prepregnancy renal function (serum creatinine below 125 μmol/l (1.4 mg/dl)) can be advised that obstetric outcome is usually successful without adverse effects on the long-term course of their disease, although there is an increased risk of antenatal complications including pre-eclampsia.