For people living with chronic kidney disease (CKD), such as complement 3 glomerulopathy (C3G) or immune complex membranoproliferative glomerulonephritis (IC-MPGN), pregnancy may be possible, but it often takes careful planning with your healthcare team.

Family planning can be important for several reasons. CKD may affect fertility, or the ability to get pregnant. It can also increase the risk of certain pregnancy complications. Some medications used to treat kidney disease may not be safe during pregnancy or while trying to conceive, so it’s important to review your treatment plan with your doctor before pregnancy.

If you’d like to have a baby in the future, talk with your nephrologist (kidney specialist) before you start trying to conceive. Your doctor can help you understand your personal risks, review your medications, and decide whether your kidney disease is stable enough for pregnancy.

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Keep reading to learn what to ask your doctor about pregnancy and CKD.

Can You Get Pregnant With Kidney Disease?

Both C3G and IC-MPGN can affect fertility, or the ability to have a pregnancy. This may include becoming pregnant or producing healthy sperm. Still, many people with kidney disease are able to get pregnant.

Even though it’s possible to get pregnant, pregnancy with CKD can come with higher risks. For that reason, pregnancy with C3G or IC-MPGN requires personalized medical guidance and close monitoring.

What To Discuss With Your Doctor

Your nephrologist can help you plan for pregnancy and talk through ways to support your health and your baby’s health. Because nephrologists may not bring up this topic on their own, consider introducing it as soon as you begin thinking about family planning.

Below are some discussion points you may want to bring up when you meet with your nephrology team.

Should I Get Preconception Counseling?

People with kidney disease who are thinking about getting pregnant may benefit from preconception counseling.

During counseling, your C3G or IC-MPGN specialist will explain any steps you may need to take before you begin trying to conceive. They may also refer you to another healthcare provider for this counseling, such as an obstetrician.

For someone with C3G or IC-MPGN, preconception counseling may include discussing:

• The possible risks of pregnancy
• Strategies for optimizing your kidney function before you conceive
• Birth control options to consider before you’re ready to conceive
• Whether you need to avoid pregnancy while taking certain medications
• Which CKD treatments may need to be adjusted during pregnancy
• Whether you’ll need any specific monitoring during your pregnancy

Your doctor can also prepare you for any possible changes to your kidney function that may occur after pregnancy. In some cases, a person’s kidney function declines while pregnant but doesn’t go back to prepregnancy levels after delivering the baby.

Is My Kidney Function Stable Enough for Pregnancy?

When your nephrologist is evaluating the best time for you to get pregnant, they’ll assess your kidney function. They may consider factors such as whether:

• Your blood pressure is within normal limits
• You have proteinuria (protein in your urine, a sign of kidney damage)
• Your kidney function tests show issues that could complicate a pregnancy

Your nephrologist may begin monitoring these measures as soon as you mention that you’re thinking about becoming pregnant.

What Type of Monitoring Will I Need During Pregnancy?

Once you’re pregnant, your care team will monitor you more closely than they would during a typical pregnancy.

Your OB-GYN may check the baby’s growth and development with standard fetal monitoring, such as ultrasounds.

Your nephrologist may order regular blood and urine tests to watch for changes in your kidney function, blood pressure, and protein levels.

Serum creatinine normally decreases during pregnancy and increases to prepregnancy levels after delivery, especially if you have early-stage CKD. Depending on the stage of your kidney disease, your nephrologist will carefully watch for any rise in creatinine compared with your earlier pregnancy levels. A rise may mean your kidney function is getting worse.

Ask your doctor how often you’ll need appointments and lab tests during pregnancy. This can help you plan ahead.

Can I Stay on My CKD Treatment Plan While I’m Pregnant?

Your nephrologist will work with your OB-GYN to determine whether you’ll need to adjust any of your treatment options during pregnancy. Depending on which C3G or IC-MPGN therapies you’re taking, your provider may have you change your dosage or switch to a new medication while you’re pregnant.

For instance, if you’ve had a kidney transplant, you’re likely taking antirejection medications, also called immunosuppressants. Some of these can be dangerous for your baby. Your C3G or IC-MPGN expert will determine whether you may need to change to a different drug during pregnancy.

Some medications used to treat kidney disease may not be safe during pregnancy. In some cases, your doctor may recommend that you avoid getting pregnant while taking certain drugs. This means you may need to use birth control until your care team says it’s safe to start trying to conceive.

If you want to become pregnant in the future, ask your nephrologist whether any of your current medications could affect pregnancy or fertility. Your doctor may recommend switching to a different treatment before you try to conceive.

Certain blood pressure drugs, such as ACE inhibitors and angiotensin-receptor blockers (ARBs), are usually not recommended during pregnancy because they may harm a developing baby. If you take one of these medications, talk with your doctor before trying to conceive or as soon as you learn you’re pregnant.

Your doctor can help you switch to a safer option, if needed. You should never stop taking any of your treatments or medications unless your doctor tells you to.

If your nephrologist does adjust your medications, you may need to wait an additional three months before getting pregnant. This allows your care team to ensure that your kidney function is stable on the new treatments.

Questions To Ask if You’re Already Pregnant

Even with careful planning, you may get pregnant without having had a chance to discuss your fertility plans with your doctor ahead of time. If you’re pregnant and you have C3G or IC-MPGN, your doctor can walk you through the essential steps to keep you and your baby healthy.

After you get pregnant, consider asking your doctor the following questions, in addition to any of those above that are relevant to you.

• How often should I check my blood pressure at home?
• Should I get genetic testing to look for mutations (variations) that may cause CKD?
• Can I deliver my baby in the standard labor and delivery room, or will I be in a special unit?
• How can I prevent my baby from being born too early?
• Will I be able to breastfeed?
• Will I need to have a cesarean delivery?
• If I need dialysis during pregnancy, can I get it?

Together, you and your care team can create a pregnancy and birth plan that supports your kidney health and your baby’s health.

Join the Conversation

On MyKidneyDiseaseTeam, people share their experiences with kidney disease, get advice, and find support from others who understand.

Did you become pregnant while living with C3G or IC-MPGN? Let others know in the comments below.