Nearly one in four women of childbearing age with chronic kidney disease (CKD) are not receiving preconception counseling, a critical conversation that helps them understand pregnancy risks and medication safety. A new study published in the July issue of Kidney Medicine found significant gaps in how kidney specialists prepare women for family planning, with important differences depending on which type of doctor provides the guidance.

Why Does Preconception Counseling Matter for Women With Kidney Disease?

Preconception counseling is a conversation between a patient and healthcare provider before pregnancy begins. For women with CKD, this discussion is especially important because pregnancy can affect kidney function, and certain kidney medications may not be safe during pregnancy. The counseling helps women understand these risks, explore medication options, and make informed decisions about family planning.

Researchers at the University of California, Los Angeles surveyed 108 women aged 18 to 45 years who were seen at an urban academic nephrology clinic. They wanted to understand how many women were receiving preconception counseling, what topics were being discussed, and how well women understood the connection between kidney disease and pregnancy.

What Did the Study Find About Counseling Gaps?

The findings revealed a troubling gap in care. While 74 percent of women reported receiving some form of preconception counseling, that means 26 percent received none at all. This is particularly concerning because preconception counseling is recommended for all patients with chronic conditions, especially those with CKD.

The type of doctor providing the counseling made a significant difference in what topics were covered. When women met with a maternal-fetal medicine specialist (a doctor who specializes in high-risk pregnancies), their conversations more often included discussions about medication safety, childbearing plans, and potential maternal and fetal complications. In contrast, conversations with nephrologists (kidney specialists) appeared to cover these topics less consistently.

Interestingly, women who received preconception counseling reported greater concern about their fertility, but they actually had less knowledge about how to manage preconception care and pregnancy with CKD. This suggests that while counseling raised awareness of potential problems, it may not have fully equipped women with practical information they needed.

How Can Healthcare Systems Improve Preconception Counseling for Women With Kidney Disease?

• Standardized Counseling Topics: Develop consistent guidelines about what should be discussed during preconception counseling, ensuring all women receive information about medication safety, pregnancy risks, and kidney function monitoring regardless of which specialist they see.
• Multidisciplinary Team Approach: Encourage collaboration between nephrologists and maternal-fetal medicine specialists so women benefit from both kidney expertise and pregnancy expertise in a coordinated way.
• Equitable Access to Specialists: Ensure that all women with CKD have access to maternal-fetal medicine providers, not just those at large academic medical centers, so counseling quality doesn't depend on where a woman receives her kidney care.

"As preconception counseling is recommended for all patients, especially those with a comorbid condition, preconception counseling for patients with CKD remains suboptimal, with 26 percent reporting no preconception counseling. Differing discussion topics between maternal-fetal medicine and nephrologists suggest a need for preconception counseling standardization and equitable access to multidisciplinary specialists," stated researchers from the study.

Study authors, University of California, Los Angeles

The research highlights an important blind spot in kidney disease care. Women with CKD who want to have children deserve clear, comprehensive information about how their condition might affect pregnancy and how to protect both their health and their baby's health. Right now, that information is not reaching everyone who needs it.

For women with kidney disease who are thinking about pregnancy, the takeaway is clear: ask your nephrologist or primary care doctor for a referral to preconception counseling. If you're not offered this conversation, request it. The discussion should cover your specific medications, how pregnancy might affect your kidney function, and what monitoring you'll need during pregnancy. Having this information before conception gives you the best chance of a healthy pregnancy and protecting your long-term kidney health.