MO1044: Understanding Perception of Pregnancy Risk in Women with Chronic Kidney Disease

Abstract

BACKGROUND AND AIMS Women with chronic kidney disease (CKD) are at increased risk of adverse pregnancy and renal outcomes, including preterm birth and progression of kidney disease. Women's risk perceptions of pregnancy impact behaviours and decisions including engagement with prenatal care, mode of delivery choices and adherence to medical advice, therefore, it is important that women perceive and understand their risk accurately. Pre-pregnancy counselling is recommended for all women with CKD, but it is unknown how women with CKD understand their pregnancy risk and if pre-pregnancy counselling affects women's perceptions. The aim of this study was to understand how a large cohort of diverse women with CKD perceive their pregnancy risk and compare differences in risk perceptions between those who have and have not received pre-pregnancy counselling. METHOD The ‘Perception of Pregnancy Risk Questionnaire’ (PPRQ;1) and ‘Desire to Avoid Pregnancy Questionnaire’ (2) were used to measure risk perception and pregnancy intention respectively. The PPRQ was adapted to assess risk perceptions in women with CKD including the severity of kidney disease. Content validity of the adapted PPRQ was confirmed by a panel of 21 experts including nephrologists, midwives, psychologists and obstetricians. Women aged between 18 and 50 years with CKD stages 1–5 were recruited from nine renal units in the United Kingdom and asked to complete an online survey (October 2020–December 2021). Clinical data were extracted from local databases. Data were analysed descriptively. RESULTS A total of 322 women completed the survey, mean age of 34.9 (SD 7.1) years. Women's obstetric history and pregnancy perspectives are described in the Table. Half of the respondents already had children (172/322; 54.1%) and three-quarters perceived pregnancy to be important or very important to themselves (241/322; 75.8%) and two-thirds (218/322; 66.7%) perceived pregnancy to be important or very important to their family. Only 109/321 (34%) of women with CKD had previously attended pre-pregnancy counselling, but those who had attended had a higher perception of pregnancy risk [51.4 (SD 21.4) versus 41.9 (SD 23.8); P < 0.0001] (0: not very severe to 100: extremely severe) and severity of kidney disease [51.3 (SD 24.9) versus 43.7 (SD 28.6); P = 0.014] compared to women who had not attended pre-pregnancy counselling. CONCLUSION This large multi-centre questionnaire study identified that risk perceptions of pregnancy for women with CKD appear to be higher than those of women with an uncomplicated pregnancy [PPRQ scores of 24.0 (SD 14.5)] [1]. However, women who had received pre-pregnancy counselling had a significantly higher perception of pregnancy risk and perceived severity of kidney disease. Limitations include a lack of measurement before and after attending a pre-pregnancy counselling clinic. Further assessment of the relationship between severity of kidney disease and perceived pregnancy risk and pregnancy intentions is needed.

Patient and Partner Perspectives of Pregnancy-Related Counseling and Information Needs in Women With Kidney Disease: An Australian National Survey

“… 8 Previous studies highlight that decisional conflicts arise when the strong desire for motherhood is balanced against risks to both maternal and fetal health. 5 , 6 , 7 , 8 , 16 Perception of pregnancy risk is also highly individualized and mediated by information synthesis, psychosocial context, and emotional responses. 6 Therefore, delivery of information and counseling to women determines their experience, engagement, and sense of autonomy.…”

“… 5 , 6 , 7 , 8 , 16 Perception of pregnancy risk is also highly individualized and mediated by information synthesis, psychosocial context, and emotional responses. 6 Therefore, delivery of information and counseling to women determines their experience, engagement, and sense of autonomy. The large proportion of women in our study who experienced loss of feeling in control of decision-making underpins the critical importance of resources and clinical support for effective SDM.…”

“… 3 , 4 In recent times, there has been a shift away from counseling against pregnancy, toward supporting reproductive autonomy through SDM, with better understanding of how women perceive pregnancy risk. 5 , 6 Previous studies have revealed that women with CKD face substantial decisional burden when balancing desire for pregnancy with concerns regarding risks to maternal, renal, and fetal health. 6 , 7 , 8 Navigating a safe pathway to pregnancy can be challenging for women with CKD.…”

“… 5 , 6 Previous studies have revealed that women with CKD face substantial decisional burden when balancing desire for pregnancy with concerns regarding risks to maternal, renal, and fetal health. 6 , 7 , 8 Navigating a safe pathway to pregnancy can be challenging for women with CKD. Preconception counseling should respect patient preferences and values, sensitively inform women of potential risks of pregnancy without catastrophizing and disengaging women, with provision of emotional and medical support.…”