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Renal Obstetrics Care in BC & Yukon – BCR Province-wide Rounds (June 2024)

Dr. Monica Beaulieu, Dr. Elizabeth Hendren and Dr. Amanda Cunningham present their talk, “Renal Obstetrics Care in BC & Yukon,” as part of BC Renal’s province-wide rounds. 0:03:10 – Intro Dr. Beaulieu begins by emphasizing the fact that pregnancy care is a human right, and that many women are not given information on the risks of pregnancy. 0:04:45 – Personal story Kate Chong, a patient partner, shares her story about being diagnosed with kidney disease and her journey to become pregnant after her diagnosis. 0:14:30 - Role of the nephrologist Dr. Hendren then talks about whether nephrologists have a role in pre-counseling patients about pregnancy, which she says should be done. For example, they have access to pre-pregnancy diagnostics (e.g., renal biopsy) to clarify pregnancy risk. However, she points to a survey showing that nephrologists are not currently offering women contraception, pre-conception and pregnancy information and counseling. Dr. Hendren notes that pregnancy is possible at all stages of CKD. She notes that nephrologists should open the conversation with their patients and reassess in follow up appointments. 0:19:55 – Common pregnancy questions Dr. Cunningham then highlights common pregnancy questions from women with kidney disease. Of note, miscarriages are not necessarily more frequent in woman with CKD, although data is limited. premature birth, gestational hypertension and pre-eclampsia are more likely in women with CKD. Dr. Cunningham provides a general overview of which medications may be stopped during pregnancy (e.g., ACE/ARB, statin, SGLT2 inhibitors, MMF, etc.). The doctors then discuss the changes in renal physiology during pregnancy, which can put some additional strain on the kidneys, but they note that studies have had mixed results about whether this impacts long-term kidney health in women with kidney disease. Risk may be low for people in early stages of kidney disease and increase with later stages of kidney disease – women with CKD 3-5 may need to start dialysis or have a transplant sooner (e.g., 1.5-5 years) after pregnancy. Chronic hypertension was closely related to disease progression, Dr. Beaulieu notes. 0:31:10 – GFR decline in Transplant Recipients Dr. Beaulieu points to some evidence that women with kidney transplants can experience a drop in renal function for the first several years post partum, but pregnancy doesn’t appear to impact on graft survival. 0:33:30 – Pregnancy Planning Dr. Cunningham provides an overview of pregnancy planning in CKD (e.g., timing, maternal risk, kidneys, fetal risk, meds & other). She shares a case example of someone with lupus and kidney disease. Dr. Hendren talks about pregnancy timing for transplant recipients. 0:41:35 – Pregnancy Counseling & Care in BC Dr. Beaulieu provides an overview of pregnancy counselling options in BC, including the renal obstetrics clinic at St. Paul’s Hospital. She points to a referral form that can be used to direct patients to the clinic. 0:45:15 – Summary and Q&A Dr. Hendren provides a summary of their key points and highlights a new publication on pregnancy counseling for CKD patients, before the team takes questions from the audience.