Pregnancy & IgAN

The Foundation for IgA Nephropathy

Pregnancy & IgAN

In pregnancy, kidney disease has long been associated with adverse outcomes for both mother and fetus. With respect to the fetus, adverse outcomes include problems such as fetal prematurity, low birth weight, and neonatal death, For the mother, adverse outcomes include preeclampsia, eclampsia, or abruptio placenta (premature placenta separation with hemorrhage).

Consistent with the above, IgAN introduces a number of complications when either being pregnant, or contemplating pregnancy. IgAN pregnancies should always be considered higher risk, but they are not impossible. Each case is different, and any woman considering pregnancy would be well-advised to consult her nephrologist or other attending physician before contemplating pregnancy.

Many women with IgAN have conceived successfully, however, your nephrologist's recommendation or advice will depend on your individual circumstances. Factors that may be considered are degree of existing renal failure (that is, what your kidney function is, and if it's less than about 70%), the amount of proteinuria you have, whether you have high blood pressure or not, and also some of your biopsy findings (any sign of significant tubulointerstitial involvement). You might be asked to wait until your IgAN is stable, if for example, you are dealing with nephrotic syndrome, or if you are having frequent "flare-ups" involving blood in the urine.

If your nephrologist agrees, you should be referred to an obstetrician who specializes in higher risk pregnancies. The principal risk revolves around a condition called "pre-eclampsia". The initial symptoms of pre-eclampsia during pregnancy are high blood pressure and protein in the urine - which many IgAN patients already have, or are prone to having. Pre-eclampsia presents a risk to both the mother and the unborn child. There is also a greater incidence of low birth weight babies due to slower than normal growth, and an undetermined but reported risk of stillbirth and of worsening renal failure during or after the pregnancy. These risks are thought to increase in proportion to the severity of the renal failure caused by IgAN.

On the other hand, pregnancy should not be automatically excluded on the basis of having IgAN. A recent study involving 60 pregnant women with IgAN, the conclusion was that "in pregnancy complicated with IgAN, if the renal function before pregnancy was satisfactory, an uneventful course of pregnancy could be expected by careful control of the patient, although the incidence of EPH-gestosis was high". EPH-gestosis means essentially the same thing as pre-eclampsia. A satisfactory renal function in this case would mean a serum creatinine somewhere under 200 umol/L (equivalent to 0.20 mmol/L in some countries, or approx. 2.3 mg/dl in the U.S.), and well-controlled hypertension (on drugs that will not harm the fetus).

Given that many IgAN patients are on ACE inhibitor or angiotensin II receptor blocker medications (or other blood pressure medications), you need to plan ahead and stop taking the medications some months before attempting pregnancy. These medications are toxic to the fetus. This has to be done in accordance with your doctor's instructions, especially if you have high blood pressure - since uncontrolled hypertension is itself a contraindication to pregnancy. In terms of pregnancy, high blood pressure is probably more risky than the IgAN itself.

So, when it comes to pregnancy, no matter what you read here or anywhere else, the bottom line has to be consulting with your nephrologist, and if necessary, whatever other medical specialists are appropriate in your case.

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