(496) Reproductive Planning in Kidney Disease: Survey of Patients with Chronic Kidney Disease and Preconception Counseling

Objective: Chronic kidney disease (CKD) is associated with greater rates of adverse maternal and fetal outcomes in pregnancy. Although preconception counseling (PCC) is recommended by the Centers for Disease Control and Prevention as primary prevention for pregnancy complications, the utilization and impact of PCC among patients with CKD is unknown.

Study Design: Patients assigned female sex at birth and aged 18-45 years with CKD who received care at a nephrology clinic in an urban academic setting received a survey between January and May 2024. In this cross-sectional analysis, data was analyzed using Chi-square test or Fisher’s exact test. Uni- and multivariable logistic regressions were performed to identify characteristics associated with inadequate PCC.

Results: Of 122 surveys distributed, 108 (88%) were completed. Overall, 74% of respondents received PCC, including 17% who received PCC from a maternal-fetal medicine (MFM) provider. Respondents who received PCC from an MFM provider were significantly more likely to report discussing medication safety, maternal complications, and fetal complications, compared to those who received PCC without an MFM provider (Table 1). PCC recipients also reported greater concern about the effect of CKD on fertility and less knowledge about preconception and pregnancy with CKD. Respondents who reported a loss of libido were more likely to report PCC (OR 3.6, 95% CI 1.2-10.5).

Conclusion: PCC for patients with CKD remains suboptimal, with 26% of respondents reporting no receipt of PCC. Our finding that topics discussed varied between MFM and non-MFM providers suggest the opportunity for PCC standardization and equitable access to MFM providers. Furthermore, our finding that patients who did not receive PCC reported lower concern and greater knowledge than PCC recipients suggests false reassurance in the setting of lack of education and reaffirms the need for PCC.