Zhonghua Fu Chan Ke Za Zhi. 2025 Dec 25;60(12):934-942. doi: 10.3760/cma.j.cn112141-20250712-00320.
ABSTRACT
Objective: To summarize the clinical characteristics, management and short-term and long-term outcomes of pregnant women with chronic kidney disease (CKD) stage 4-5. Methods: The clinical data of pregnant women with CKD stage 4-5 admitted by the multidisciplinary team (MDT) of CKD pregnancy management in the Third Affiliated Hospital of Chongqing Medical University from September 2019 to July 2024 were collected and retrospectively analyzed, including medical history, laboratory examination, pregnancy outcome, treatment options, and renal function outcome. To summarize the experience of prenatal counseling, pregnancy management, dialysis indications and lifestyle intervention in pregnant women with CKD stage 4-5. Results: A total of 10 pregnant women with CKD stage 4-5 were enrolled, aged (29.0±4.2) years (range: 23 to 36 years). Among the 10 cases, 3 cases were induced abortion in the second trimester, 1 case had missed abortion in the first trimester, and 6 cases were finally delivered successfully. Renal biopsy was performed in 4 cases to determine the type of primary nephropathy, and genetic testing was performed in 4 cases to confirm the diagnosis of hereditary nephropathy. Among the six CKD stage 4-5 pregnant women who successfully delivered, three started dialysis treatment in the second and third trimesters of pregnancy, and the other three started dialysis treatment immediately, 5.5 months and 18.3 months after delivery, respectively. All pregnant women were terminated by cesarean section and none of them had postpartum hemorrhage. The gestational age at delivery was (33.8±1.1) weeks (range: 32+1 to 35+1 weeks). All neonates were premature, with no fetal death and neonatal death. Two cases were small for gestational age and the other four were appropriate for gestational age. The length of neonatal intensive care unit (NICU) stay was (23.0±11.0) days (range: 10 to 38 days). No serious complications occurred during NICU stay. All newborns grew and developed well during the follow-up period of 10-60 months. Conclusions: CKD stage 4-5 is not an absolute contraindication for pregnancy. Comprehensive evaluation of doctor-patient shared decision-making on the premise of sufficient doctor-patient communication, precise management of MDT, close maternal and fetal monitoring, lifestyle medical intervention and timely initiation of dialysis can help pregnant women with CKD stage 4-5 achieve safe pregnancy and good maternal and fetal outcomes.
PMID:41456894 | DOI:10.3760/cma.j.cn112141-20250712-00320