Having a baby when you have kidney, heart, or cancer risks
May 26, 2020
Managing chronic kidney disease, a heart defect, or cancer can feel like a full-time job. And for thousands of patients a year, that workload increases when they discover they're pregnant.
Many women with these illnesses believe they can't get pregnant due to their illness or treatment, but that's often not the case. For example, the UT Southwestern Maternal-Fetal Medicine (MFM) team is caring for patients who live with these diseases on a daily basis.
For some patients, the scenario is reversed. They find out they're pregnant and are later diagnosed with a chronic condition.
In either case, our MFMs work closely with specialists in nephrology, cardiology, and oncology to create custom care plans for our high-risk moms.
Kidney disease
Kidney disease comes in two forms: primary and secondary. Primary kidney disease affects only the kidneys. Secondary refers to kidney disease caused by conditions that affect the whole body, such as lupus, high blood pressure, or diabetes.
When a patient is not pregnant, the kidneys typically filter about 200 quarts (50 gallons) of blood a day. By the third trimester of pregnancy, a patient's blood volume increases by 40% to 50%, which means the kidneys must work even harder.
However, kidney disease can cause the kidneys to lose function and eventually even stop working. As a result, they spill proteins into the urine that would normally serve specific functions, such as preventing blood clots.
Pregnancy risks associated with kidney disease include:
- Blood clots
- Fetal growth restriction
- Preterm delivery
- Preeclampsia – high blood pressure during pregnancy
- Stillbirth
Vaginal delivery is preferred, if possible. Your doctor may recommend induction of labor or cesarean section (C-section) if you or the baby develop health concerns.
Related reading: Kidney disease and pregnancy: It’s challenging, but possible
If you had the condition before pregnancy
Patients with well-controlled kidney disease typically have better outcomes. Poor kidney function is likely to worsen during pregnancy. In some patients, the damage may be irreversible, accelerating the need for dialysis or a kidney transplant.
Ideally, patients should visit with a doctor before becoming pregnant. We can help optimize your overall health and kidney function to increase your chances of better outcomes.
A common myth is that women on dialysis cannot get pregnant. This is not true! And pregnancy in the setting of dialysis most often ends with an adverse pregnancy outcome. Dialysis sessions have to be modified, usually resulting in shorter, more frequent sessions.
Transplantation is not safe during pregnancy – we recommend waiting at least 18 months after a transplant to get pregnant.
If you are diagnosed during pregnancy
During pregnancy, we check urine for protein and serum for creatinine. If either of these are elevated, kidney dysfunction may be suspected.
Your MFM may recommend that you see a nephrologist (kidney doctor) and other specialists to get your kidney function and any other related conditions evaluated. Therapies might include diet changes, medication, and/or dialysis.
Congenital heart disease
Congenital heart disease (CHD) refers to a heart defect present at birth – nearly 2% of people born in the U.S. have one. Between 2000 and 2010, 9 per 10,000 women admitted for delivery had a CHD.
Some CHDs cause lifelong issues, such as abnormal heart rhythm (arrhythmia) or increased risk of heart failure. However, many CHDs cause no problems until adulthood. In fact, some patients never know they have one until their pregnancy workups reveal an issue.
During pregnancy, the amount of blood in your body increases. The extra volume means the heart works 30% to 50% harder. However, with careful planning and expert care, most women with CHD can have a successful pregnancy.
Women with CHD face increased risk for pregnancy complications, which may include fetal growth restriction, preterm delivery, or the need for mom to be hospitalized or stay in the intensive care unit.
Your doctor may restrict your activity in the third trimester to reduce stress on your heart. You may be admitted to the hospital prior to labor for monitoring. Vaginal delivery is safe in most cases. However, we may recommend planned induction so the care team can prepare in case of emergency.
If you had the condition before pregnancy
See an MFM and a cardiologist with CHD expertise prior to pregnancy, if possible. If you are already pregnant, get in as soon as you can.
Your doctors will review your medications and may recommend changing some drugs or dosages. For example, they may prescribe blood thinners to reduce the risk of blood clots.
If you have a mechanical heart valve, you may need additional monitoring to reduce blood clot risks. In patients with a severe CHD such as hypertrophic cardiomyopathy or an aortic aneurysm, pregnancy may not be recommended.
Related reading: Erica’s pregnancy story of a heart attack at 31, baby at 36
Cancer
Positive outcomes are possible for patients with cancer.
Breast cancer is the most commonly diagnosed cancer during pregnancy. If found during or within a year after pregnancy, it is called pregnancy-associated breast cancer (PABC). PABC occurs in 20% of patients with breast cancer who are younger than 30. This is just 0.4% of all breast cancers diagnosed in women age 16 to 49.
Cervical cancer affects 1 in 1,200 to 10,000 pregnancies, so it is somewhat rare. Cervical cancer may be detected based on results from routine pelvic exams or pap smears at the beginning of pregnancy.
Lymphoma affects 1 in 1,000 to 6,000 pregnancies. Leukemia is less common, affecting 1 in 75,000 pregnancies. These blood cancers can be detected during standard pregnancy blood work. Both cancers are more common in younger patients, and for many women, pregnancy is the first time they see a doctor as an adult. This may explain why blood cancers are often diagnosed during pregnancy.
If possible, visit with an MFM prior to becoming pregnant. The better your general health, the better your outcomes will be.
During pregnancy, your MFM will work closely with your oncologist to manage your care. You will receive more ultrasounds and tests to check the baby's growth and the volume of fluid around the baby.
Most cancer tests and therapies can and should continue during pregnancy. This includes biopsies, chemotherapy, and certain surgeries. PET scans, however, should be avoided due to potential fetal risks related to the radiation used in the exam.
Vaginal delivery is preferred, if possible. Cancer treatment can reduce immunity, increasing the risk of infection as the C-section incision heals. Your doctor may recommend induction of labor a few weeks early to further your cancer treatment while balancing the risks of prematurity.
If you had the condition before pregnancy
Research from the American Society of Clinical Oncology shows that chemotherapy is generally safe during pregnancy. Your doctors may recommend pausing chemo during the first trimester while the baby's organs take shape. Complications in the second and third trimesters are rare but may include blood clots, fetal growth restriction, low amniotic fluid levels, or stillbirth.
If you are diagnosed during pregnancy
Of the three cancer types, breast cancer is more challenging to diagnose during pregnancy. Breast tissue swells and changes during pregnancy, so cancers found may be larger and more advanced.
Your care team will help you navigate the physical and emotional challenges of a cancer diagnosis. UT Southwestern is an academic medical center, which means our cancer experts see patients on the same campus as our MFM team. Patients can get seamless referrals to cancer support services, including counseling.
Chronic conditions may complicate pregnancy, but for many patients, positive outcomes are possible with careful planning and expert care.
If you have kidney disease, a heart condition, or cancer, meet with an MFM specialist before you become pregnant. We can help you optimize your health to give you the best chance at a successful outcome.
To visit with an MFM, call 214-645-8300 or request an appointment online.
