Rozemarijn Snoek1,2, Rieke van der Graaf3, Jildau R Meinderts4, Franka van Reekum5, Kitty W M Bloemenkamp6, Nine V A M Knoers1,7, Albertien M van Eerde1,2, A Titia Lely8. 1. Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 2. Center for Molecular Medicine, Utrecht University, Utrecht, The Netherlands. 3. Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 4. Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 5. Department of Nephrology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 6. Department of Obstetrics, Birth Centre Wilhelmina Children's Hospital, University Medical Center Utrecht, Division Women and Baby, Utrecht University, Utrecht, The Netherlands. 7. Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 8. Department of Obstetrics, Birth Centre Wilhelmina Children's Hospital, University Medical Center Utrecht, Division Women and Baby, Utrecht University, Utrecht, The Netherlands, a.t.lely@umcutrecht.nl.
Abstract
BACKGROUND: Thanks to the advances in care, pregnancy is now attainable for the majority of young female CKD patients, although it is still a high-risk endeavor. Clinical decision-making in these cases is impacted by a myriad of factors, making (pre)pregnancy counseling a complex process. The complexities, further impacted by limited data and unknown risks regarding outcome, can cause discussions when deciding on the best care for a specific patient. OBJECTIVES: In this article, we provide an overview of the considerations and dilemmas we encounter in preconception counseling and offer our perspective on how to deal with them in daily clinical practice. METHODS: The main topics we discuss in our counseling are (1) the high risk of pregnancy complications, (2) the risk of permanent CKD deterioration due to pregnancy and subsequent decreased life expectancy, (3) appropriate changes in renal medication, and (4) assisted reproduction, genetic testing, and prenatal or preimplantation genetic diagnostics. RESULTS AND CONCLUSIONS: In our clinic, we openly address moral dilemmas arising in clinical practice in pregnancy and CKD, both within the physician team and with the patient. We do this by ensuring an interpretive physician-patient interaction and shared decision-making, deliberating in a multidisciplinary setting and, if needed, with input from an expert committee.
BACKGROUND: Thanks to the advances in care, pregnancy is now attainable for the majority of young female CKD patients, although it is still a high-risk endeavor. Clinical decision-making in these cases is impacted by a myriad of factors, making (pre)pregnancy counseling a complex process. The complexities, further impacted by limited data and unknown risks regarding outcome, can cause discussions when deciding on the best care for a specific patient. OBJECTIVES: In this article, we provide an overview of the considerations and dilemmas we encounter in preconception counseling and offer our perspective on how to deal with them in daily clinical practice. METHODS: The main topics we discuss in our counseling are (1) the high risk of pregnancy complications, (2) the risk of permanent CKD deterioration due to pregnancy and subsequent decreased life expectancy, (3) appropriate changes in renal medication, and (4) assisted reproduction, genetic testing, and prenatal or preimplantation genetic diagnostics. RESULTS AND CONCLUSIONS: In our clinic, we openly address moral dilemmas arising in clinical practice in pregnancy and CKD, both within the physician team and with the patient. We do this by ensuring an interpretive physician-patient interaction and shared decision-making, deliberating in a multidisciplinary setting and, if needed, with input from an expert committee.
Authors: G L Harton; M De Rycke; F Fiorentino; C Moutou; S SenGupta; J Traeger-Synodinos; J C Harper Journal: Hum Reprod Date: 2010-10-21 Impact factor: 6.918
Authors: N A Deshpande; N T James; L M Kucirka; B J Boyarsky; J M Garonzik-Wang; R A Montgomery; D L Segev Journal: Am J Transplant Date: 2011-07-27 Impact factor: 8.086
Authors: Marleen C van Buren; Denise K Beck; A Titia Lely; Jacqueline van de Wetering; Emma K Massey Journal: Clin Transplant Date: 2021-09-28 Impact factor: 3.456
Authors: Rozemarijn Snoek; Marijn F Stokman; Klaske D Lichtenbelt; Theodora C van Tilborg; Cindy E Simcox; Aimée D C Paulussen; Jos C M F Dreesen; Franka van Reekum; A Titia Lely; Nine V A M Knoers; Christine E M de Die-Smulders; Albertien M van Eerde Journal: Clin J Am Soc Nephrol Date: 2020-08-27 Impact factor: 8.237