LAUSR

Abstract BACKGROUND AND AIMS Women with chronic kidney disease (CKD) are at increased risk of adverse pregnancy and renal outcomes, including preterm birth and progression of kidney disease. Women's risk perceptions of pregnancy impact behaviours and decisions including engagement with prenatal care, mode of delivery choices and adherence to medical advice, therefore, it is important that women perceive and understand their risk accurately. Pre-pregnancy counselling is recommended for all women with CKD, but it is unknown how women with CKD understand their pregnancy risk and if pre-pregnancy counselling affects women's perceptions. The aim of this study was to understand how a large cohort of diverse women with CKD perceive their pregnancy risk and compare differences in risk perceptions between those who have and have not received pre-pregnancy counselling. METHOD The ‘Perception of Pregnancy Risk Questionnaire’ (PPRQ;1) and ‘Desire to Avoid Pregnancy Questionnaire’ (2) were used to measure risk perception and pregnancy intention respectively. The PPRQ was adapted to assess risk perceptions in women with CKD including the severity of kidney disease. Content validity of the adapted PPRQ was confirmed by a panel of 21 experts including nephrologists, midwives, psychologists and obstetricians. Women aged between 18 and 50 years with CKD stages 1–5 were recruited from nine renal units in the United Kingdom and asked to complete an online survey (October 2020–December 2021). Clinical data were extracted from local databases. Data were analysed descriptively. RESULTS A total of 322 women completed the survey, mean age of 34.9 (SD 7.1) years. Women's obstetric history and pregnancy perspectives are described in the Table. Half of the respondents already had children (172/322; 54.1%) and three-quarters perceived pregnancy to be important or very important to themselves (241/322; 75.8%) and two-thirds (218/322; 66.7%) perceived pregnancy to be important or very important to their family. Only 109/321 (34%) of women with CKD had previously attended pre-pregnancy counselling, but those who had attended had a higher perception of pregnancy risk [51.4 (SD 21.4) versus 41.9 (SD 23.8); P < 0.0001] (0: not very severe to 100: extremely severe) and severity of kidney disease [51.3 (SD 24.9) versus 43.7 (SD 28.6); P = 0.014] compared to women who had not attended pre-pregnancy counselling. CONCLUSION This large multi-centre questionnaire study identified that risk perceptions of pregnancy for women with CKD appear to be higher than those of women with an uncomplicated pregnancy [PPRQ scores of 24.0 (SD 14.5)] [1]. However, women who had received pre-pregnancy counselling had a significantly higher perception of pregnancy risk and perceived severity of kidney disease. Limitations include a lack of measurement before and after attending a pre-pregnancy counselling clinic. Further assessment of the relationship between severity of kidney disease and perceived pregnancy risk and pregnancy intentions is needed.Table 1. Comparison by awareness of influenza vaccination Not aware of influenza vaccine N = 21 Aware of influenza vaccine N = 65 P-value Clinic respondents, n (%)Telephone respondents, n (%) 7 (33.3)14 (66.7) 38 (58.5)27 (41.5) 0.045 Age at screening, years 53.2 (40.1, 59.0) 39.2 (30.6, 52.6) 0.02 Male, n (%) 8 (38.1) 25 (38.5) 0.98 English spoken at home, n (%) 7 (33.3) 43 (66.2) 0.008 English spoken at healthcare, n (%) 16 (76.2) 62 (95.3) 0.03 Secondary school education or below, n (%) 11 (52.4) 14 (21.5) 0.007 Professional or executive, n (%) 6 (28.6) 37 (56.9) 0.02 Income above $2000/month, n (%) 10 (55.6) 48 (84.2) 0.02 Disease duration, months 33 (15, 53) 40 (19, 59) 0.43 Aware of COVID-19 vaccine, n (%) 21 (100) 65 (100) - Received COVID-19 vaccine, n (%) 20 (95.2) 52 (80.0) 0.17 Health literacy index 32.6 (30.1, 38.5) 33.3 (30.5, 38.6) 0.72 Categorical variables were presented as number (percentage) and compared using the Pearson chi-squared or Fisher's exact test as appropriate. Continuous variables were presented as medians with interquartile ranges [IQR (25th percentile, 75th percentile)] and compared using the Mann–Whitney U test. P-values < 0.05 were considered statistically significant.Table 2. Factors associated with influenza vaccine awareness after adjusting for survey type Adjusted Odds Ratio 95% Confidence Interval P-value Age at screening, per 1 year increase 0.95 0.92–0.99 0.02 Male compared to female 1.03 0.36–2.91 0.96 English spoken at home, yes 3.19 1.07–9.47 0.04 English spoken at healthcare, yes 8.87 1.70–46.37 0.01 Secondary school education or below, yes 0.23 0.08–0.68 0.008 Professional or executive, yes 3.36 1.20–10.93 0.02 Income above $2000/month, yes 4.03 1.19–16.63 0.03 Disease duration, per 1 month increase 1.01 0.98–1.03 0.63 Received COVID-19 vaccine, yes 3.34 0.38–29.47 0.28 Health literacy index, per unit increase 0.95 0.86–1.06 0.35