At 38, is it safe to get pregnant with stage 3 CKD?

Question

Hello, Doctor,

I am a 38 year old woman recently diagnosed with stage 3 CKD after years of high blood pressure and anemia. My creatinine is 2.1 mg/dL, and eGFR is around 42 mL/min. I have also been having irregular periods and noticed swelling around my ankles.

My gynecologist said I might be having early hormonal changes due to kidney issues. I’m scared because I’ve been trying to conceive for a year. I’m on iron supplements and blood pressure medicines. Please tell me,

Can CKD cause early menopause or fertility problems?
Is pregnancy even safe with my kidney function?
Will it worsen my condition?
Are these safe if I get pregnant?
Are there any dietary changes that can help protect my kidneys while balancing my reproductive health?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Yes, chronic kidney disease can affect your reproductive hormones and menstrual cycle. Your kidneys help regulate hormones such as estrogen, progesterone, and prolactin. As chronic kidney disease progresses, especially from stage 3 onward, estrogen levels may decrease while prolactin levels may rise. Because of this, you may develop irregular periods, missed periods, difficulty releasing eggs regularly, and symptoms that can resemble early menopause.

Many women with chronic kidney disease also experience reduced fertility. However, pregnancy is still possible in some cases, although it may be more difficult and requires close monitoring by both your nephrologist and gynecologist.

With an estimated glomerular filtration rate (GFR) of around 42 milliliters per minute and a creatinine level of 2.1 milligrams per deciliter, pregnancy would be considered high risk for both you and the baby. There is a risk that your kidney function could worsen during or after pregnancy, especially if your blood pressure is not well controlled. You may also have an increased risk of high blood pressure, preeclampsia, anemia, fluid retention, preterm delivery, and low birth weight in the baby.

Despite these risks, many women with stage 3 chronic kidney disease have had successful pregnancies with careful planning and close medical supervision. Before trying to conceive, you should undergo pre-pregnancy counseling and make sure your condition is stable.

You should also assess the following things,

Urine protein-to-creatinine ratio, as significant protein loss can increase pregnancy risks.
Your serum creatinine must be more than 120 micromol/L.
Your serum albumin must be assessed. If it is below 30 g/L, or your GFR is less than 45 mL/min, pregnancy may carry a substantial risk, and you may be advised not to become pregnant until your condition is better stabilized.

These decisions should always be made together with your nephrologist and maternal-fetal medicine specialist.

I hope this information helps you.

Feel free to ask further queries.

Thank you.