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.

慢性肾脏病 (CKD) 与生育能力下降和不良妊娠结局风险增加有关。先兆子痫、胎儿生长受限和早产的发生率随着 CKD 和蛋白尿的严重程度而增加。孕前咨询可以促进知情决策。希望延迟或避免怀孕的妇女需要安全有效的避孕措施。为希望怀孕的女性制定怀孕计划包括适当替代已知的致畸剂——包括吗替麦考酚酯、血管紧张素阻滞剂和环磷酰胺——并有助于优化疾病控制。然而，妊娠可能发生在任何阶段的 CKD 女性身上，可能会加剧贫血、维生素 D 缺乏和高血压等合并症。增加血液透析供应与改善透析妇女的妊娠结局有关。CKD 女性先兆子痫的诊断在既往存在高血压和蛋白尿的患者中很复杂，但可以通过使用血管活性生物标志物以及胎盘和胎儿多普勒超声来改善。CKD 中使用的新药的妊娠数据有限，因为妊娠和 CKD 是药物和干预试验的常见排除标准。虽然对于较旧的药物可能有前瞻性数据，但妊娠期使用的大多数药物是基于回顾性数据和专家共识。CKD 女性先兆子痫的诊断在既往存在高血压和蛋白尿的患者中很复杂，但可以通过使用血管活性生物标志物以及胎盘和胎儿多普勒超声来改善。CKD 中使用的新药的妊娠数据有限，因为妊娠和 CKD 是药物和干预试验的常见排除标准。虽然对于较旧的药物可能有前瞻性数据，但妊娠期使用的大多数药物是基于回顾性数据和专家共识。CKD 女性先兆子痫的诊断在既往存在高血压和蛋白尿的患者中很复杂，但可以通过使用血管活性生物标志物以及胎盘和胎儿多普勒超声来改善。CKD 中使用的新药的妊娠数据有限，因为妊娠和 CKD 是药物和干预试验的常见排除标准。虽然对于较旧的药物可能有前瞻性数据，但妊娠期使用的大多数药物是基于回顾性数据和专家共识。