Pre-pregnancy care and counselling in chronic renal patients

Pre-pregnancy planning in chronic renal patients has relied mainly on information gleaned from case reports, small series and variable registries. Nevertheless, guidelines have emerged to help clinicians in the care of their patients, so that as with other chronic medical conditions, it is becoming recognised as part of the traditional organisation of care associated with pregnancy. Nevertheless, most chronic renal patients do not plan their pregnancies with their health care team, and this complex behaviour is affected by the quality of the relationship with the team and by the woman’s attitude to her health and beliefs. The basic components of pre-pregnancy counselling should be analysis of risks, provision of health education and advice, and then making specific helpful interventions. Such ‘active preparation for pregnancy’ should be individualised to each woman’s needs and involve her partner. The ethical controversies associated with the need to understand the psychology of women who pursue parenthood, despite substantial risk to their own health and that of their unborn baby, should not be underestimated.