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  • Review Article
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Reproductive health and pregnancy in women with chronic kidney disease

Nature Reviews Nephrology volume 14, pages 165–184 (2018)Cite this article

Subjects

Key Points

  • Although chronic kidney disease (CKD) adversely affects fertility, pregnancies can occur at all stages of CKD severity

  • Safe and effective contraception should be made available for all women with CKD who do not wish to conceive and those who take teratogenic medications

  • CKD increases the risk of adverse pregnancy outcomes, including pre-eclampsia, fetal growth restriction, preterm delivery and post-partum loss of maternal renal function

  • Pre-pregnancy hypertension and proteinuria in CKD complicate the diagnosis of superimposed pre-eclampsia, which could be improved through vasoactive biomarkers as well as placental and fetal Doppler ultrasound

  • Although data on the use of many drugs in pregnancy are limited, low-dose aspirin, low-molecular-weight heparin, labetalol, nifedipine, prednisolone, hydroxychloroquine, azathioprine, ciclosporin and tacrolimus are considered safe during pregnancy and breastfeeding

Abstract

Chronic kidney disease (CKD) is associated with reduced fertility and an increased risk of adverse pregnancy outcomes. Rates of pre-eclampsia, fetal growth restriction and preterm delivery increase incrementally with the severity of CKD and proteinuria. Pre-pregnancy counselling can facilitate informed decision-making. Safe and effective contraception is required for women who wish to delay or avoid pregnancy. Pregnancy planning for women who wish to conceive involves appropriate substitution of known teratogens — including mycophenolate mofetil, angiotensin blockers and cyclophosphamide — and can aid optimization of disease control. However, pregnancy, which can occur in women with any stage of CKD, can exacerbate comorbidities such as anaemia, vitamin D deficiency and hypertension. Increased haemodialysis provision is associated with improved pregnancy outcomes for women on dialysis. Diagnosis of pre-eclampsia in women with CKD is complicated in patients with pre-existing hypertension and proteinuria but can be improved by the use of vasoactive biomarkers as well as placental and fetal Doppler ultrasound. Pregnancy data for newer drugs used in CKD are limited as pregnancy and CKD are common exclusion criteria for drug and intervention trials. Although prospective data may be available for older drugs, the use of most drugs in pregnancy is based on retrospective data and expert consensus.

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Figure 1: Endocrine effects of chronic kidney disease on the hypothalamic–pituitary–ovarian axis.
Figure 2: Physiological changes in the renal system in pregnancy.
Figure 3: Adverse pregnancy outcomes according to chronic kidney disease stage.

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References

  1. Piccoli, G. B. et al. Pregnancy and chronic kidney disease: a challenge in all CKD stages. Clin. J. Am. Soc. Nephrol. 5, 844–855 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bramham, K. et al. Pregnancy in renal transplant recipients: a UK national cohort study. Clin. J. Am. Soc. Nephrol. 8, 290–298 (2013).

    Article  CAS  PubMed  Google Scholar 

  3. Piccoli, G. B. et al. Outcomes of pregnancies after kidney transplantation: lessons learned from CKD. A comparison of transplanted, nontransplanted chronic kidney disease patients and low-risk pregnancies: a multicenter nationwide analysis. Transplantation 101, 2536–2544 (2017).

    Article  PubMed  Google Scholar 

  4. Webster, P., Lightstone, L., McKay, D. B. & Josephson, M. A. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 91, 1047–1056 (2017).

    Article  PubMed  Google Scholar 

  5. Hladunewich, M. A., Melamad, N. & Bramham, K. Pregnancy across the spectrum of chronic kidney disease. Kidney Int. 89, 995–1007 (2016).

    Article  PubMed  Google Scholar 

  6. Knight, M., Kurinczuk, J. J., Tuffnell, D. & Brocklehurst, P. The UK Obstetric Surveillance System for rare disorders of pregnancy. BJOG 112, 263–265 (2005).

    Article  PubMed  Google Scholar 

  7. [No authors listed.] Statistical bulletin: conceptions in England and Wales 2015. Office for National Statistics https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/bulletins/conceptionstatistics/2015#main-points (2017).

  8. Piccoli, G. B. et al. The children of dialysis: live-born babies from on-dialysis mothers in Italy — an epidemiological perspective comparing dialysis, kidney transplantation and the overall population. Nephrol. Dial. Transplant. 29, 1578–1586 (2014).

    Article  PubMed  Google Scholar 

  9. Basok, E. K. et al. Assessment of female sexual function and quality of life in predialysis, peritoneal dialysis, hemodialysis, and renal transplant patients. Int. Urol. Nephrol. 41, 473–481 (2009).

    Article  PubMed  Google Scholar 

  10. Finkelstein, F. O., Shirani, S., Wuerth, D. & Finkelstein, S. H. Therapy insight: sexual dysfunction in patients with chronic kidney disease. Nat. Clin. Pract. Nephrol. 3, 200–207 (2007).

    Article  PubMed  Google Scholar 

  11. Steele, T. E. et al. Sexual experience of the chronic peritoneal dialysis patient. J. Am. Soc. Nephrol. 7, 1165–1168 (1996).

    CAS  PubMed  Google Scholar 

  12. Solak, Y. et al. Effects of sildenafil and vardenafil treatments on sleep quality and depression in hemodialysis patients with erectile dysfunction. Int.J. Impot. Res. 23, 27–31 (2011).

    Article  CAS  PubMed  Google Scholar 

  13. Holley, J. L., Schmidt, R. J., Bender, F. H., Dumler, F. & Schiff, M. Gynecologic and reproductive issues in women on dialysis. Am. J. Kidney Dis. 29, 685–690 (1997).

    Article  CAS  PubMed  Google Scholar 

  14. Lim, V. S., Henriquez, C., Sievertsen, G. & Frohman, L. A. Ovarian function in chronic renal failure: Evidence suggesting hypothalamic anovulation. Ann. Intern. Med. 93, 21–27 (1980).

    Article  CAS  PubMed  Google Scholar 

  15. Wang, G. C. et al. Measurements of serum pituitary-gonadal hormones and investigation of sexual and reproductive functions in kidney transplant recipients. Int. J. Nephrol. 2010, 612126 (2010).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Palmer, B. F. & Clegg, D. J. Gonadal dysfunction in chronic kidney disease. Rev. Endocr. Metab. Disord. 18, 17–30 (2017).

    Article  CAS  Google Scholar 

  17. Holley, J. L. & Schmidt, R. J. Changes in fertility and hormone replacement therapy in kidney disease. Adv. Chron. Kidney Dis. 20, 240–245 (2013).

    Article  Google Scholar 

  18. Yavuz, D., Topçu, G., Ozene, r C., Akalin, S. & Sirikçi, O. Macroprolactin does not contribute to elevated levels of prolactin in patients on renal replacement therapy. Clin. Endocrinol. 63, 520–524 (2005).

    Article  CAS  Google Scholar 

  19. Weinhandl, E. D., Liu, J., Gilbertson, D. T., Arneson, T. J. & Collins, A. J. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J. Am. Soc. Nephrol. 23, 895–904 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Rocco, M. V. et al. The effects of frequent nocturnal home hemodialysis: the frequent hemodialysis network nocturnal trial. Kidney Int. 80, 1080–1091 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Finkelstein, F. O. et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 82, 561–569 (2012).

    Article  PubMed  Google Scholar 

  22. van Eps, C. et al. Changes in serum prolactin, sex hormones and thyroid function with alternate nightly nocturnal home haemodialysis. Nephrology 17, 42–47 (2012).

    Article  CAS  PubMed  Google Scholar 

  23. Hladunewich, M. & Schatell, D. Intensive dialysis and pregnancy. Hemodial. Int. 20, 339–348 (2016).

    Article  PubMed  Google Scholar 

  24. Barua, M. et al. Successful pregnancies on nocturnal home hemodialysis. Clin. J. Am. Soc. Nephrol. 3, 392–396 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Meistrich, M. L., Wilson, G., Brown, B. W., da Cunha, M. F. & Lipshultz, L. I. Impact of cyclophosphamide on long-term reduction in sperm count in men treated with combination chemotherapy for ewing and soft tissue sarcomas. Cancer 70, 2703–2712 (1992).

    Article  CAS  PubMed  Google Scholar 

  26. Boumpas, D. T. et al. Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Ann. Intern. Med. 119, 366–369 (1993).

    Article  CAS  PubMed  Google Scholar 

  27. Ioannidis, J. P., Katsifis, G. E., Tzioufas, A. G. & Moutsopoulos, H. M. Predictors of sustained amenorrhea from pulsed intravenous cyclophosphamide in premenopausal women with systemic lupus erythematosus. J. Rheumatol. 29, 2129–2135 (2002).

    CAS  PubMed  Google Scholar 

  28. Bellver, J. & Pellicer, A. Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome. Fertil. Steril. 92, 1803–1810 (2009).

    Article  PubMed  Google Scholar 

  29. Elizur, S. E. et al. Fertility preservation treatment for young women with autoimmune diseases facing treatment with gonadotoxic agents. Rheumatology 47, 506–1509 (2008).

    Article  CAS  Google Scholar 

  30. Somers, E. C., Marder, W., Christman, G. M., Ognenovski, V. & McCune, W. J. Use of a gonadotropin-releasing hormone analog for protection against premature ovarian failure during cyclophosphamide therapy in women with severe lupus. Arthritis Rheum. 52, 2761–2767 (2005).

    Article  CAS  PubMed  Google Scholar 

  31. Moore, H. C. et al. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N. Engl. J. Med. 372, 923–932 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Lambertini, M. et al. Ovarian suppression with triptorelin during adjuvant breast cancer chemotherapy and long-term ovarian function, pregnancies, and disease-free survival: a randomized clinical trial. JAMA 314, 2632–2640 (2015).

    Article  CAS  PubMed  Google Scholar 

  33. Lambertini, M. et al. Ovarian suppression using luteinizing hormone-releasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients: a meta-analysis of randomized studies. Ann. Oncol. 26, 2408–2419 (2015).

    Article  CAS  PubMed  Google Scholar 

  34. Shah, P. S. et al. Intention to become pregnant and low birth weight and preterm birth: a systematic review. Maternal Child Health J. 15, 205–216 (2009).

    Article  Google Scholar 

  35. Yildirim, Y. & Uslu, A. Pregnancy in patients with previous successful renal transplantation. Int. J. Gynaecol. Obstet. 90, 198–202 (2005).

    Article  CAS  PubMed  Google Scholar 

  36. Trussell, J. Contraceptive failure in the United States. Contraception 83, 397–404 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Korver, T. et al. Maintenance of ovulation inhibition with the 75-microg desogestrel-only contraceptive pill (Cerazette) after scheduled 12-h delays in tablet intake. Contraception 71, 8–13 (2005).

    Article  CAS  PubMed  Google Scholar 

  38. Estes, C. M. & Westhoff, C. Contraception for the transplant patient. Semin. Perinatol. 31, 372–377 (2007).

    Article  PubMed  Google Scholar 

  39. Krajewski, C. M., Geetha, D. & Gomez-Lobo, V. Contraceptive options for women with a history of solid-organ transplantation. Transplantation 95, 1183–1186 (2013).

    Article  CAS  PubMed  Google Scholar 

  40. Morrison, C. S. et al. Is the intrauterine device appropriate contraception for HIV-1 infected women? BJOG 108, 784–790 (2001).

    CAS  PubMed  Google Scholar 

  41. Ramhendar, T. & Byrne, P. Use of the levonorgestrel-releasing intrauterine system in renal transplant recipients: a retrospective case review. Contraception 86, 288–289 (2012).

    Article  CAS  PubMed  Google Scholar 

  42. Brynhildsen, J. Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks. Ther. Adv. Drug Saf. 5, 201–213 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Davison, J. M. & Dunlop, W. Renal hemodynamics and tubular function in normal human pregnancy. Kidney Int. 18, 152–161 (1980).

    Article  CAS  PubMed  Google Scholar 

  44. Helal, I., Fick-Brosnahan, G. M., Reed-Gitomer, B. & Schrier, R. W. Glomerular hyperfiltration: definitions, mechanisms and clinical implications. Nat. Rev. Nephrol. 8, 293–300 (2012).

    Article  CAS  PubMed  Google Scholar 

  45. Roberts, M., Lindheimer, M. D. & Davison, J. M. Altered glomerular permselectivity to neutral dextrans and heteroporous membrane modelling in human pregnancy. Am. J. Physiol. 270, F338–F343 (1996).

    CAS  PubMed  Google Scholar 

  46. Milne, J. E. C., Lindheimer, M. D. & Davison, J. M. Glomerular heteroporous membrane modeling in third trimester and postpartum before and during amino acid infusion. Am. J. Physiol. Renal Physiol. 282, F170–F175 (2002).

    Article  CAS  PubMed  Google Scholar 

  47. Conrad, K. P. & Davison, J. M. The renal circulation in normal pregnancy and preeclampsia: is there a place for relaxin? Am. J. Physiol. Renal Physiol. 306, F1121–F1135 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Novak, J. et al. Relaxin is essential for renal vasodilation during pregnancy in conscious rats. J. Clin. Invest. 107, 1469–1475 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Jeyabalan, A. et al. Essential role for vascular gelatinase activity in relaxin-induced renal vasodilation, hyperfiltration, and reduced myogenic reactivity of small arteries. Circ. Res. 93, 1249–1257 (2003).

    Article  CAS  PubMed  Google Scholar 

  50. Cadnapaphornchai, M. A. et al. Chronic NOS inhibition reverses systemic vasodilation and glomerular hyperfiltration in pregnancy. Am. J. Physiol. Renal Physiol. 280, F592–F598 (2001).

    Article  CAS  PubMed  Google Scholar 

  51. Conrad, K. P. & Baker, V. L. Corpus luteal contribution to maternal pregnancy physiology and outcomes in assisted reproductive technologies. Am. J. Physiol. Regul. Integr. Comp. Physiol. 304, R69–R72 (2013).

    Article  CAS  PubMed  Google Scholar 

  52. Odutayo, A. & Hladunewich, M. Obstetric nephrology: renal hemodynamic and metabolic physiology in normal pregnancy. Clin. J. Am. Soc. Nephrol. 7, 2073–2080 (2012).

    Article  PubMed  Google Scholar 

  53. Smith, M. C., Moran, P., Ward, M. K. & Davison, J. M. Assessment of glomerular filtration rate during pregnancy using the MDRD formula. BJOG 115, 109–112 (2008).

    Article  CAS  PubMed  Google Scholar 

  54. Alper, A. B. et al. Performance of estimated glomerular filtration rate prediction equations in preeclamptic patients. Am. J. Perinatol. 28, 425–430 (2010).

    Article  PubMed  Google Scholar 

  55. Kristensen, K. et al. Temporal changes of the plasma levels of cystatin C, beta-trace protein, beta2-microglobulin, urate and creatinine during pregnancy indicate continuous alterations in the renal filtration process. Scand. J. Clin. Lab Invest. 67, 612–618 (2007).

    Article  CAS  PubMed  Google Scholar 

  56. Kristensen, K., Strevens, H., Lindström, V. & Grubb, A. Wide-Swensson, D. Increased plasma levels of beta2-microglobulin, cystatin C and beta-trace protein in term pregnancy are not due to utero-placental production. Scand. J. Clin. Lab Invest. 68, 649–653 (2008).

    Article  CAS  PubMed  Google Scholar 

  57. Strevens, H., Wide-Swensson, D., Torffvit, O. & Grubb, A. Serum cystatin C for assessment of glomerular filtration rate in pregnant and non-pregnant women. Indications of altered filtration process in pregnancy. Scand. J. Clin. Lab Invest. 62, 141–147 (2002).

    Article  CAS  PubMed  Google Scholar 

  58. Bramham, K., Makanjuola, D., Hussein, W., Cafful, D. & Shehata, H. Serum cystatin is not a marker of glomerular filtration rate in pregnancy. Obstet. Med. 2, 121–122 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  59. Larsson, A., Palm, M., Hansson, L. O. & Axelsson, O. Cystatin C and modification of diet in renal disease (MDRD) estimated glomerular filtration rate differ during normal pregnancy. Acta Obstet. Gynecol. Scand. 89, 939–944 (2010).

    Article  CAS  PubMed  Google Scholar 

  60. Piccoli, G. B. et al. Risk of adverse pregnancy outcomes in women with CKD. J. Am. Soc. Nephrol. 26, 2011–2022 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Gambaro, G. et al. Increased urinary excretion of glycosaminoglycans in pregnancy and in diabetes mellitus: a protective factor against nephrolithiasis. Nephron 50, 62–63 (1988).

    Article  CAS  PubMed  Google Scholar 

  62. Butler, E. L., Cox, S. M., Eberts, E. G. & Cunningham, F. G. Symptomatic nephrolithiasis complicating pregnancy. Obstet. Gynecol. 96, 753–756 (2000).

    CAS  PubMed  Google Scholar 

  63. Williams, K. P. & Galerneau, F. The role of serum uric acid as a prognostic indicator of the severity of maternal and fetal complications in hypertensive pregnancies. J. Obstet. Gynaecol. Can. 24, 628–632 (2002).

    Article  PubMed  Google Scholar 

  64. Verdonk, K., Visser, W., Van Den Meiracker, A. H. & Danser, A. H. The renin-angiotensin-aldosterone system in pre-eclampsia: the delicate balance between good and bad. Clin. Sci. 126, 537–544 (2014).

    Article  CAS  Google Scholar 

  65. Davison, J. M. & Lindheimer, M. D. Volume homeostasis and osmoregulation in human pregnancy. Baillieres Clin. Endocrinol. Metab. 3, 451–472 (1989).

    Article  CAS  PubMed  Google Scholar 

  66. [No authors listed.] Pregnancy and renal disease. Lancet 306, 801–802 (1975).

  67. Tong, A., Brown, M. A., Winkelmayer, W. C., Craig, J. C. & Jesudason, S. Perspectives on pregnancy in women with CKD: a semistructured interview study. Am. J. Kidney Dis. 66, 951–961 (2015).

    Article  PubMed  Google Scholar 

  68. Tong, A., Jesudason, S., Craig, J. C. & Winkelmayer, W. C. Perspectives on pregnancy in women with chronic kidney disease: systematic review of qualitative studies. Nephrol. Dial. Transplant. 30, 652–661 (2015).

    Article  PubMed  Google Scholar 

  69. Knight, M. et al. Saving Lives, Improving Mothers' Care — Surveillance of maternal deaths in the UK 2012–2014 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–2014. (National Perinatal Epidemiology Unit, University of Oxford, 2016).

    Google Scholar 

  70. Wiles, K. S. et al. Pre-pregnancy counselling in chronic kidney disease: a retrospective analysis of nine years' experience. BMC Nephrol. 16, 28 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  71. Kendrick, J. et al. Kidney disease and maternal and fetal outcomes in pregnancy. Am. J. Kidney Dis. 66, 55–59 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Zhang, J. J. et al. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin. J. Am. Soc. Nephrol. 10, 1964–1978 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Moroni, G. et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study. J. Autoimmun. 74, 6–12 (2016).

    Article  PubMed  Google Scholar 

  74. Piccoli, G. B. et al. Maternal-foetal outcomes in pregnant women with glomerulonephritides. Are all glomerulonephritides alike in pregnancy? J. Autoimmun. 79, 91–98 (2017).

    Article  PubMed  Google Scholar 

  75. Chapman, A. B., Johnson, A. M. & Gabow, P. A. Pregnancy outcome and its relationship to progression of renal failure in autosomal dominant polycystic kidney disease. J. Am. Soc. Nephrol. 5, 1178–1185 (1994).

    CAS  PubMed  Google Scholar 

  76. Jones, D. C. & Hayslett, J. P. Outcome of pregnancy in women with moderate or severe renal insufficiency. N. Engl. J. Med. 335, 226–232 (1996).

    Article  CAS  PubMed  Google Scholar 

  77. Imbasciati, E. et al. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am. J. Kidney Diseases. 49, 753–762 (2007).

    Article  Google Scholar 

  78. Bramham, K. et al. Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease. Kidney Int. 89, 874–885 (2016).

    Article  CAS  PubMed  Google Scholar 

  79. Willey, C. J. et al. Prevalence of autosomal dominant polycystic kidney disease in the European Union. Nephrol. Dial. Transplant. 32, 1356–1363 (2017).

    PubMed  Google Scholar 

  80. Wu, M. et al. Pregnancy outcomes in autosomal dominant polycystic kidney disease: a case-control study. J. Matern. Fetal Neonatal Med. 29, 807–812 (2016).

    Article  PubMed  Google Scholar 

  81. Jung, J. H. et al. Successful pregnancy in a patient with autosomal dominant polycystic kidney disease on long-term hemodialysis. J. Kor. Med. Sci. 29, 301–304 (2014).

    Article  Google Scholar 

  82. Swift, O., Vilar, E., Rahman, B., Side, L. & Gale, D. P. Attitudes in patients with autosomal dominant polycystic kidney disease toward prenatal diagnosis and preimplantation genetic diagnosis. Genet. Test. Mol. Biomarkers 20, 741–746 (2016).

    Article  PubMed  Google Scholar 

  83. Blom, K., Odutayo, A., Bramham, K. & Hladunewich, M. A. Pregnancy and glomerular disease: a systematic review of the literature with management guidelines. Clin. J. Am. Soc. Nephrol. 12, 1862–1872 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Jungers, P. et al. Chronic kidney disease and pregnancy. Adv. Nephrol. Necker Hosp. 15, 103–141 (1986).

    CAS  PubMed  Google Scholar 

  85. Abe, S., et al. The influence of antecedent renal disease on pregnancy. Am. J. Obstet. Gynecol. 153, 508–514 (1985).

    Article  CAS  PubMed  Google Scholar 

  86. Packham, D., Whitworth, J. A., Fairley, K. F. & Kincaid-Smith, P. Histological features of IgA glomerulonephritis as predictors of pregnancy outcome. Clin. Nephrol. 30, 22–26 (1988).

    CAS  PubMed  Google Scholar 

  87. Limardo, M. et al. Pregnancy and progression of IgA nephropathy: results of an Italian multicenter study. Am. J. Kidney Dis. 56, 506–512 (2010).

    Article  PubMed  Google Scholar 

  88. Hoover, P. J. & Costenbader, K. H. Insights into the epidemiology and management of lupus nephritis from the US rheumatologist's perspective. Kidney Int. 90, 487–492 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  89. Imbasciati, E. et al. Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome. Nephrol. Dial. Transplant. 24, 519–525 (2009).

    Article  PubMed  Google Scholar 

  90. Bramham, K. et al. Pregnancy outcomes in systemic lupus erythematosus with and without previous nephritis. J. Rheumatol. 38, 1906–1913 (2011).

    Article  PubMed  Google Scholar 

  91. Smyth, A. et al. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin. J. Am. Soc. Nephrol. 5, 2060–2068 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Chakravarty, E. F. et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am. J. Obstet. Gynecol. 192, 1897–1904 (2005).

    Article  PubMed  Google Scholar 

  93. Buyon, J. P. et al. Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann. Intern. Med. 163, 153–163 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  94. Moroni, G. et al. Maternal outcome in pregnant women with lupus nephritis: a prospective multicenter study. J. Autoimmun. 74, 194–200 (2016).

    Article  PubMed  Google Scholar 

  95. Royal College of Obstetricians and Gynaecologists. Reducing the risk of venous thromboembolism in pregnancy and the puerperium. Green Top Guideline 37a https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf (2015).

  96. Cimaz, R., Spence, D. L., Hornberger, L. & Silverman, E. D. Incidence and spectrum of neonatal lupus erythematosus: a prospective study of infants born to mothers with anti-Ro autoantibodies. J. Pediatr. 142, 678–683 (2003).

    Article  PubMed  Google Scholar 

  97. Andreoli, L. et al. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann. Rheum. Dis. 6, 476–485 (2017).

    Article  CAS  Google Scholar 

  98. Izmirly, P. M. et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 126, 76–82 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  99. Klemetti, M. M. et al. Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011. Diabetologia 58, 678–686 (2015).

    Article  CAS  PubMed  Google Scholar 

  100. Piccoli, G. B. et al. Type 1 diabetes, diabetic nephropathy, and pregnancy: a systematic review and meta-study. Rev. Diabet. Stud. 10, 6–26 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  101. Bell, R., Glinianaia, S. V., Tennant, P. W., Bilous, R. W. & Rankin, J. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia 55, 936–947 (2012).

    Article  CAS  Google Scholar 

  102. Hod, M. et al. Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome. Nephrol. Dialysis Transplant. 10, 2328–2333 (1995).

    Article  CAS  Google Scholar 

  103. Bar, J. et al. Pregnancy outcome in patients with insulin dependent diabetes mellitus and diabetic nephropathy treated with ACE inhibitors before pregnancy. J. Pediatr. Endocrinol. Metab. 12, 659–666 (1999).

    Article  CAS  PubMed  Google Scholar 

  104. Nielsen, L. R., Damm, P. & Mathiesen, E. R. Improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy: effect of intensified antihypertensive therapy? Diabetes Care. 32, 38–44 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. Bramham, K. Diabetic nephropathy and pregnancy. Semin. Nephrol. 37, 362–369 (2017).

    Article  PubMed  Google Scholar 

  106. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. http://apps.who.int/iris/bitstream/10665/250796/1/9789241549912-eng.pdf?ua=1 (2016).

  107. Pavord, S. et al. UK guidelines on the management of iron deficiency in pregnancy. Br. J. Haematol. 156, 588–600 (2012).

    Article  CAS  PubMed  Google Scholar 

  108. Steer, P., Alam, M. A., Wadsworth, J. & Welch, A. Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. BMJ 310, 489–491 (1995).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. McMullin, M. F., White, R., Lappin, T., Reeves, J. & MacKenzie, G. Haemoglobin during pregnancy: relationship to erythropoietin and haematinic status. Eur. J. Haematol. 71, 44–50 (2003).

    Article  CAS  PubMed  Google Scholar 

  110. Sienas, L., Wong, T., Collins, R. & Smith, J. Contemporary uses of erythropoietin in pregnancy: a literature review. Obstet. Gynecol. Surv. 68, 594–602 (2013).

    Article  PubMed  Google Scholar 

  111. Sanchez-Gonzalez, L. R. et al. Efficacy and safety of adjuvant recombinant human erythropoietin and ferrous sulfate as treatment for iron deficiency anemia during the third trimester of pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol. 205, 32–36 (2016).

    Article  CAS  PubMed  Google Scholar 

  112. de Benoist, B., McLean, E., Egll, I. & Cogswell, M. Worldwide prevalence of anaemia 1993–2005. WHO Global Database on Anaemia (World Health Organization, 2008).

    Google Scholar 

  113. Gaweda, A. E. Markers of iron status in chronic kidney disease. Hemodial. Int. 21 (Suppl. 1), S21–27 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  114. Albaramki, J., Hodson, E. M., Craig, J. C. & Webster, A. C. Parenteral versus oral iron therapy for adults and children with chronic kidney disease. Cochrane Database Syst Rev. 1, CD007857 (2012).

    PubMed  Google Scholar 

  115. Tariq, N., Ayub, R., Khan, W. U., Ijaz, S. & Alam, A. Y. Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy: a randomized controlled trial. J. Coll. Physicians Surg. Pak. 25, 193–197 (2015).

    PubMed  Google Scholar 

  116. Kriplani, A. et al. Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy. Indian J. Med. Res. 138, 78–82 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  117. Al, R. A. et al. Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial. Obstet. Gynecol. 106, 1335–1340 (2005).

    Article  CAS  PubMed  Google Scholar 

  118. al-Momen, A. K. et al. Intravenous iron sucrose complex in the treatment of iron deficiency anemia during pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol. 69, 121–124 (1996).

    Article  CAS  PubMed  Google Scholar 

  119. Moll, R. &. Davis, B. Iron, vitamin B12 and folate. Clin. Sci. 45, 198–203 (2017).

    Google Scholar 

  120. Maxwell, P. H. & Eckardt, K. U. HIF prolyl hydroxylase inhibitors for the treatment of renal anaemia and beyond. Nat. Rev. Nephrol. 12, 157–168 (2016).

    Article  CAS  PubMed  Google Scholar 

  121. Royal College of Obstetricians and Gynaecologists. Vitamin D in Pregnancy. Scientific Impact Paper Number 43 https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/vitamin_d_sip43_june14.pdf (2014).

  122. De-Regil, L. M., Palacios, C., Lombardo, L. K. & Peña-Rosas, J. P. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst. Rev. 2, CD008873 (2016).

    Google Scholar 

  123. Palacios, C., De-Regil, L. M., Lombardo, L. K. & Peña-Rosas, J. P. Vitamin D supplementation during pregnancy: updated meta-analysis on maternal outcomes. J. Steroid Biochem. Mol. Biol. 164, 148–155 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  124. World Health Organization. Vitamin D supplementation in pregnancy. http://www.who.int/nutrition/publications/micronutrients/guidelines/vit_d_supp_pregnant_women/en/ (2012).

  125. Tamblyn, J. A. et al. Dysregulation of maternal and placental vitamin D metabolism in preeclampsia. Placenta 50, 70–77 (2017).

    Article  CAS  PubMed  Google Scholar 

  126. Turner, M., Barré, P. E., Benjamin, A., Goltzman, D. & Gascon-Barré, M. Does the maternal kidney contribute to the increased circulating 1,25-dihydroxyvitamin D concentrations during pregnancy? Miner. Electrolyte Metab. 14, 246–252 (1988).

    CAS  PubMed  Google Scholar 

  127. Hewison, M., Zehnder, D., Chakraverty, R. & Adams, J. S. Vitamin D and barrier function: a novel role for extra-renal 1 alpha-hydroxylase. Mol. Cell Endocrinol. 215, 31–38 (2004).

    Article  CAS  PubMed  Google Scholar 

  128. Bramham, K. et al. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ 348, g2301 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  129. Magee, L. A. et al. Less-tight versus tight control of hypertension in pregnancy. N. Engl. J. Med. 372, 407–417 (2015).

    Article  CAS  PubMed  Google Scholar 

  130. Bramham, K., Hall, M., Lightstone, L. & Nelson-Piercy, C. Renal Disease in Pregnancy 2nd edn (Cambridge Univ. Press, in press).

  131. Li, D. K., Yang, C., Andrade, S., Tavares, V. & Ferber, J. R. Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study. BMJ 343, d5931 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  132. Bateman, B. T. et al. Angiotensin-converting enzyme inhibitors and the risk of congenital malformations. Obstet. Gynecol. 129, 174–184 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  133. US National Library of Medicine. Drugs and Lactation Database (LactMed). TOXNET https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm (2017).

  134. Nice, F. J. et al. Medications and breast-feeding: a guide for pharmacists, pharmacy technicians, and other healthcare professionals part II. J. Pharmacy Technol. 20, 85–95 (2004).

    Article  Google Scholar 

  135. Benediktsson, R., Calder, A. A., Edwards, C. R. & Seckl, J. R. Placental 11 beta-hydroxysteroid dehydrogenase: a key regulator of fetal glucocorticoid exposure. Clin. Endocrinol. 46, 161–166 (1997).

    Article  CAS  Google Scholar 

  136. van Runnard Heimel, P. J., Schobben, A. F., Huisjes, A. J., Franx, A. & Bruinse, H. W. The transplacental passage of prednisolone in pregnancies complicated by early-onset HELLP syndrome. Placenta 26, 842–845 (2005).

    Article  CAS  PubMed  Google Scholar 

  137. Laskin, C. A. et al. Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal loss. N. Engl. J. Med. 337, 148–153 (1997).

    Article  CAS  PubMed  Google Scholar 

  138. Park-Wyllie, L. et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 62, 385–392 (2000).

    Article  CAS  PubMed  Google Scholar 

  139. Carmichael, S. L. et al. Maternal corticosteroid use and orofacial clefts. Am. J. Obstet. Gynecol. 197, 585.e1–585.e7 (2007).

    Article  CAS  Google Scholar 

  140. Källén, B. Maternal drug use and infant cleft lip/palate with special reference to corticoids. Cleft Palate Craniofac. J. 40, 624–628 (2003).

    Article  PubMed  Google Scholar 

  141. Czeizel, A. E. & Rockenbauer, M. Population-based case-control study of teratogenic potential of corticosteroids. Teratology 56, 335–340 (1997).

    Article  CAS  PubMed  Google Scholar 

  142. Tata, L. J. et al. Effect of maternal asthma, exacerbations and asthma medication use on congenital malformations in offspring: a UK population-based study. Thorax 63, 981–987 (2008).

    Article  CAS  PubMed  Google Scholar 

  143. Hviid, A. & Mølgaard-Nielsen, D. Corticosteroid use during pregnancy and risk of orofacial clefts. CMAJ 183, 796–804 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  144. Norwood, F. et al. Myasthenia in pregnancy: best practice guidelines from a UK multispecialty working group. J. Neurol. Neurosurg. Psychiatry 85, 538–543 (2014).

    Article  PubMed  Google Scholar 

  145. Francella, A. et al. The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Gastroenterology 124, 9–17 (2003).

    Article  CAS  PubMed  Google Scholar 

  146. lint, J. et al. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology 55, 1693–1697 (2016).

    Article  CAS  Google Scholar 

  147. Götestam Skorpen, C. et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann. Rheum. Dis. 75, 795–810 (2016).

    Article  PubMed  CAS  Google Scholar 

  148. Ostensen, M. et al. Pregnancy and reproduction in autoimmune rheumatic diseases. Rheumatology 50, 657–664 (2011).

    Article  PubMed  Google Scholar 

  149. Sau, A. et al. Azathioprine and breastfeeding: is it safe? BJOG 114, 498–501 (2007).

    Article  CAS  PubMed  Google Scholar 

  150. Sifontis, N. M. et al. Pregnancy outcomes in solid organ transplant recipients with exposure to mycophenolate mofetil or sirolimus. Transplantation 82, 1698–1702 (2006).

    Article  CAS  PubMed  Google Scholar 

  151. Perez-Aytes, A. et al. In utero exposure to mycophenolate mofetil: a characteristic phenotype? Am. J. Med. Genet. A 146A, 1–7 (2008).

    Article  PubMed  Google Scholar 

  152. Bar Oz, B., Hackman, R., Einarson, T. & Koren, G. Pregnancy outcome after cyclosporine therapy during pregnancy: a meta-analysis. Transplantation 71, 1051–1055 (2001).

    Article  CAS  PubMed  Google Scholar 

  153. Kainz, A., Harabacz, I., Cowlrick, I. S., Gadgil, S. D. & Hagiwara, D. Review of the course and outcome of 100 pregnancies in 84 women treated with tacrolimus. Transplantation. 70, 1718–1721 (2000).

    Article  CAS  PubMed  Google Scholar 

  154. Chakkera, H. A., Kudva, Y. & Kaplan, B. Calcineurin inhibitors: pharmacologic mechanisms impacting both insulin resistance and insulin secretion leading to glucose dysregulation and diabetes mellitus. Clin. Pharmacol. Ther. 101, 114–120 (2017).

    Article  CAS  PubMed  Google Scholar 

  155. Zheng, S. et al. Pharmacokinetics of tacrolimus during pregnancy. Ther. Drug Monit. 34, 660–670 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  156. Bramham, K., Chusney, G., Lee, J., Lightstone, L. & Nelson-Piercy, C. Breastfeeding and tacrolimus: serial monitoring in breast-fed and bottle-fed infants. Clin. J. Am. Soc. Nephrol. 8, 563–567 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  157. Wallace, D. J., Gudsoorkar, V. S., Weisman, M. H. & Venuturupalli, S. R. New insights into mechanisms of therapeutic effects of antimalarial agents in SLE. Nat. Rev. Rheumatol. 8, 522–533 (2012).

    Article  CAS  PubMed  Google Scholar 

  158. Kaplan, Y. C., Ozsarfati, J., Nickel, C. & Koren, G. Reproductive outcomes following hydroxychloroquine use for autoimmune diseases: a systematic review and meta-analysis. Br. J. Clin. Pharmacol. 81, 835–848 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  159. Clowse, M. E., Magder, L., Witter, F. & Petri, M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum. 54, 3640–3647 (2006).

    Article  PubMed  Google Scholar 

  160. Marmor, M. F., Kellner, U., Lai, T. Y., Melles, R. B. & Mieler, W. F. American Academy of Ophthalmology recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology 123, 1386–1394 (2016).

    Article  PubMed  Google Scholar 

  161. Zemlickis, D. et al. Fetal outcome after in utero exposure to cancer chemotherapy. Arch. Intern. Med. 152, 573–576 (1992).

    Article  CAS  PubMed  Google Scholar 

  162. United States Food and Drug Administration. Rituxan final labeling text https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/103705s5311lbl.pdf (2010).

  163. Chakravarty, E. F., Murray, E. R., Kelman, A. & Farmer, P. Pregnancy outcomes after maternal exposure to rituximab. Blood 117, 1499–1506 (2011).

    Article  CAS  PubMed  Google Scholar 

  164. Bruel, A. et al. Hemolytic uremic syndrome in pregnancy and postpartum. Clin. J. Am. Soc. Nephrol. https://doi.org/10.2215/CJN.00280117(2017).

  165. Kelly, R. J. et al. Eculizumab in pregnant patients with paroxysmal nocturnal hemoglobinuria. N. Engl. J. Med. 373, 1032–1039 (2015).

    Article  CAS  PubMed  Google Scholar 

  166. National Institute for Health and Care Excellence. Hypertension in pregnancy: the management of hypertensive disorders in pregnancy. (RCOG Press, 2011).

  167. Henderson, J. T. et al. Low-dose aspirin for the prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U. S. Preventive Services Task Force. Ann. Intern. Med. 160, 695–703 (2014).

    Article  PubMed  Google Scholar 

  168. Rolnik, D. L. et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N. Engl. J. Med. 377, 613–622 (2017).

    Article  CAS  PubMed  Google Scholar 

  169. Poon, L. C. et al. Aspirin for evidence-based preeclampsia prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history. Am. J. Obstet. Gynecol. 217, 585.e1–585.e5 (2017).

    Article  CAS  Google Scholar 

  170. Datta, P., Rewers-Felkins, K., Kallem, R. R., Baker, T. & Hale, T. W. Transfer of low dose aspirin into human milk. J. Hum. Lact. 33, 296–299 (2017).

    Article  PubMed  Google Scholar 

  171. Edling, K. L. et al. A pregnant dilemma: primary hyperparathyroidism due to parathyromatosis in pregnancy. Endocr. Pract. 20, e14–e17 (2014).

    Article  PubMed  Google Scholar 

  172. Nadarasa, K. et al. The use of cinacalcet in pregnancy to treat a complex case of parathyroid carcinoma. Endocrinol. Diabetes Metab. Case Rep. 2014, 140056 (2014).

    CAS  PubMed  PubMed Central  Google Scholar 

  173. Hoeltzenbein, M., Stieler, K., Panse, M., Wacker, E. & Schaefer, C. Allopurinol use during pregnancy — outcome of 31 prospectively ascertained cases and a phenotype possibly indicative for teratogenicity. PLoS ONE 8, e66637 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  174. Indraratna, P. L., Virk, S., Gurram, D. & Day, R. O. Use of colchicine in pregnancy: a systematic review and meta-analysis. Rheumatology https://doi.org/10.1093/rheumatology/kex353 (2017).

  175. Piccoli, G. B. et al. Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrol. Dial. Transplant. 31, 1915–1934 (2016).

    Article  PubMed  Google Scholar 

  176. Hou, S. H. Frequency and outcome of pregnancy in women on dialysis. Am. J. Kidney Dis. 23, 60–63 (1994).

    Article  CAS  PubMed  Google Scholar 

  177. Hladunewich, M. A. et al. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J. Am. Soc. Nephrol. 25, 1103–1109 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  178. Asamiya, Y. et al. The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int. 75, 1217–1222 (2009).

    Article  CAS  PubMed  Google Scholar 

  179. Piccoli, G. B. et al. Pre-eclampsia or chronic kidney disease? The flow hypothesis. Nephrol. Dial. Transplant. 28, 1199–1206 (2013).

    Article  CAS  PubMed  Google Scholar 

  180. Agrawal, S., Cerdeira, A., S., Redman, C. & Vatish, M. Meta-analysis and systematic review to assess the role of soluble fms-like tyrosine recpetor kinase and placental growth factor ratio in prediction of preeclampsia: the SaPPhirE study. Hypertension https://doi.org/10.1161/HYPERTENSIONAHA.117.10182 (2017).

  181. Chappell, L. C. et al. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation 128, 2121–2131 (2013).

    Article  CAS  PubMed  Google Scholar 

  182. Kim, M. Y. et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. Am. J. Obstet. Gynecol. 214, 108.e1–108.e14 (2016).

    Article  CAS  Google Scholar 

  183. Akbari, A. et al. Circulating angiogenic factors in a pregnant woman on intensive hemodialysis: a case report. Can. J. Kidney Health Dis. 3, 7 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  184. Thadhani, R. et al. Removal of soluble fms-like tyrosine kinase-1 by dextran sulfate apheresis in preeclampsia. J. Am. Soc. Nephrol. 27, 903–913 (2016).

    Article  CAS  PubMed  Google Scholar 

  185. Williams, D. & Davison, J. Chronic kidney disease in pregnancy. BMJ 336, 211 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors acknowledge the US National Institute for Health Research (NIHR) Rare Diseases Translational Research Collaboration as well as the Biomedical Research Centre at Guy's and St. Thomas' UK National Health Service (NHS) Foundation Trust and King's College London for funding K.W. under the terms of a doctoral research fellowship. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the UK Department of Health.

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Authors and Affiliations

  1. Women's Health Academic Centre, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    Kate S. Wiles

  2. Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK

    Kate S. Wiles & Catherine Nelson-Piercy

  3. Imperial Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK

    Catherine Nelson-Piercy

  4. King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK

    Kate Bramham

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  1. Kate S. Wiles
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K.W., C.N.P. and K.B. contributed equally to the conception, design, drafting and revision of this article.

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Correspondence to Kate S. Wiles or Catherine Nelson-Piercy.

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PowerPoint slides

Glossary

Amenorrhoea

The absence of menstruation.

Ovarian stimulation

The use of drugs to stimulate oocyte development in the ovary before retrieval for artificial reproductive techniques.

Natural-cycle oocyte retrieval

Oocyte retrieval from the ovary following a normal menstrual cycle, without the use of stimulatory drugs.

'Mini pill'

An oral contraceptive pill that contains a synthetic progestogen (no oestrogen).

Intrauterine device

(IUD). A small birth control device that is inserted into the uterus to prevent pregnancy. May contain a slow-releasing progestogen (for example, Mirena) or offer contraception without hormonal release (copper coil).

Subdermal implant

A small device inserted under the skin. The contraceptive implant delivers an effective dose of a synthetic progestogen, providing long-acting, reversible contraception.

Progestogen

A synthetic form of progesterone.

'Combined pill'

Contraceptive pill containing a synthetic oestrogen and progestogen.

Transdermal patch

Contraceptive patch that delivers synthetic oestrogen and progestogen through the skin.

Vaginal ring

A soft plastic ring worn inside the vagina that provides contraception via the release of synthetic oestrogen and progestogen.

Corpus luteum

The remnants of the ovarian follicle after ovulation.

Pre-implantation genetic diagnosis

(PGD). Examination of the genetic profile of a gamete or embryo before implantation.

Ribonucleoproteins

Protein–RNA complexes.

Endocardial fibroelastosis

A disease of the endocardium characterized by collagen deposition, endocardial thickening and ventricular hypertrophy.

Macrosomia

A large-for-gestational-age infant.

Hyperparathyroidism

Increase in parathyroid hormone levels, which can be primary due to pathology within the parathyroid gland or secondary due to hypocalcaemia or hyperphosphataemia (both of which can be caused by CKD).

Supratherapeutic dosing

Administering a drug dose that is higher than that needed to achieve therapeutic effects.

Diaphragmatic hernia

Congenital defect in the diaphragm that allows movement of abdominal viscera into the chest.

Microtia

A congenital abnormality in which the pinna (external ear) is underdeveloped.

Micrognathia

A congenital abnormality in which the jaw is underdeveloped.

Doppler ultrasound

The use of sound waves to detect movement. This technique is used in pregnancy to examine the vascular waveform in uterine and umbilical arteries to predict or diagnose pathology.

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Wiles, K., Nelson-Piercy, C. & Bramham, K. Reproductive health and pregnancy in women with chronic kidney disease. Nat Rev Nephrol 14, 165–184 (2018). https://doi.org/10.1038/nrneph.2017.187

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