Exploring Biopsychosocial Correlates of Pregnancy Risk and Pregnancy Intention in Women with Chronic Kidney Disease

TY - JOUR

T1 - Exploring Biopsychosocial Correlates of Pregnancy Risk and Pregnancy Intention in Women with Chronic Kidney Disease

AU - Ralston, Elizabeth R

AU - Smith, Priscilla

AU - Clark, Katherine

AU - Wiles, Kate

AU - RaDaR CKD Pregnancy Group, null

AU - Chilcot, Joseph

AU - Bramham, Kate

N1 - Funding Information: We would like to thank all women who participated in the study and the clinical care team at; King’s College Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, North Bristol NHS Trust, Guy’s and St Thomas’s NHS Foundation Trust, East Kent Hospitals University NHS Foundation Trust, Bart’s Health NHS Trust, Manchester University NHS Foundation Trust, Nottingham University Hospital NHS Trust and Imperial College Healthcare NHS Trust. Thank you to the RaDaR CKD Pregnancy group for facilitating recruitment, especially: Dr Laura Baines, Dr Laura Skinner, Dr Kate Smith-Jackson, Dr Alison Armitage, Dr Philip Webster, Dr Matt Hall, Dr Taryn Pile, Professor Jenny Myers and with thanks to Professor Chris Farmer. Thank you to the National Institute of Health Research (NIHR). The views expressed in this article are those of the authors and not necessarily those of the National Health Service nor the NIHR. Funding Information: This work undertaken as part of a PhD project funded by King’s College Hospital Joint Medical Research Committee and Project Grant from Kidney Research UK to Elizabeth Ralston. Publisher Copyright: © 2023, The Author(s).

PY - 2023/6/1

Y1 - 2023/6/1

N2 - Introduction: Women with Chronic Kidney Disease (CKD) are at increased risk of adverse pregnancy and renal outcomes. It is unknown how women with CKD understand their pregnancy risk. This nine-centre, cross-sectional study aimed to explore how women with CKD perceive their pregnancy risk and its impact on pregnancy intention, and identify associations between biopsychosocial factors and perception of pregnancy risk and intention. Methods: Women with CKD in the UK completed an online survey measuring their pregnancy preferences; perceived CKD severity; perception of pregnancy risk; pregnancy intention; distress; social support; illness perceptions and quality of life. Clinical data were extracted from local databases. Multivariable regression analyses were performed. Trial registration: NCT04370769. Results: Three hundred fifteen women participated, with a median estimated glomerular filtration rate (eGFR) of 64 ml/min/1.73m2(IQR 56). Pregnancy was important or very important in 234 (74%) women. Only 108 (34%) had attended pre-pregnancy counselling. After adjustment, there was no association between clinical characteristics and women’s perceived pregnancy risk nor pregnancy intention. Women’s perceived severity of their CKD and attending pre-pregnancy counselling were independent predictors of perceived pregnancy risk. Importance of pregnancy was an independent predictor of pregnancy intention but there was no correlation between perceived pregnancy risk and pregnancy intention (r = − 0.002, 95% CI − 0.12 to 0.11). Discussion: Known clinical predictors of pregnancy risk for women with CKD were not associated with women’s perceived pregnancy risk nor pregnancy intention. Importance of pregnancy in women with CKD is high, and influences pregnancy intention, whereas perception of pregnancy risk does not. Graphical abstract: [Figure not available: see fulltext.]

AB - Introduction: Women with Chronic Kidney Disease (CKD) are at increased risk of adverse pregnancy and renal outcomes. It is unknown how women with CKD understand their pregnancy risk. This nine-centre, cross-sectional study aimed to explore how women with CKD perceive their pregnancy risk and its impact on pregnancy intention, and identify associations between biopsychosocial factors and perception of pregnancy risk and intention. Methods: Women with CKD in the UK completed an online survey measuring their pregnancy preferences; perceived CKD severity; perception of pregnancy risk; pregnancy intention; distress; social support; illness perceptions and quality of life. Clinical data were extracted from local databases. Multivariable regression analyses were performed. Trial registration: NCT04370769. Results: Three hundred fifteen women participated, with a median estimated glomerular filtration rate (eGFR) of 64 ml/min/1.73m2(IQR 56). Pregnancy was important or very important in 234 (74%) women. Only 108 (34%) had attended pre-pregnancy counselling. After adjustment, there was no association between clinical characteristics and women’s perceived pregnancy risk nor pregnancy intention. Women’s perceived severity of their CKD and attending pre-pregnancy counselling were independent predictors of perceived pregnancy risk. Importance of pregnancy was an independent predictor of pregnancy intention but there was no correlation between perceived pregnancy risk and pregnancy intention (r = − 0.002, 95% CI − 0.12 to 0.11). Discussion: Known clinical predictors of pregnancy risk for women with CKD were not associated with women’s perceived pregnancy risk nor pregnancy intention. Importance of pregnancy in women with CKD is high, and influences pregnancy intention, whereas perception of pregnancy risk does not. Graphical abstract: [Figure not available: see fulltext.]

UR - http://www.scopus.com/inward/record.url?scp=85151084762&partnerID=8YFLogxK

U2 - 10.1007/s40620-023-01610-2

DO - 10.1007/s40620-023-01610-2

M3 - Article

SN - 1121-8428

VL - 36

SP - 1361

EP - 1372

JO - JOURNAL OF NEPHROLOGY

JF - JOURNAL OF NEPHROLOGY

IS - 5

ER -