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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Sex, fertility and pregnancy

This is a referral page, not a how-to

Pregnancy with kidney disease and type 1 diabetes must be planned before you try, with your nephrologist, your diabetes team and a maternal-fetal medicine (high-risk pregnancy) specialist (UK Kidney Association 2019, guidelines 1.1 and 3.3.1; KDIGO 2009 transplant, 25.2.6). This page explains why and what to ask. It does not replace that planning. Never stop or change a medicine on your own, even if you find out you are pregnant: call the prescriber the same day.

In short

Sexual problems are common with kidney disease: about half of people with CKD report them (KDIGO 2024, Figure 49). They can often be treated, so raise them. Fertility falls as kidney function falls, and periods often become irregular on dialysis, but pregnancy can still happen, so use reliable contraception unless you are planning a pregnancy (NKF; UK Kidney Association, 3.1.1). Pregnancy is riskier at higher CKD stages, on dialysis and after a transplant, and some kidney and transplant medicines can harm a baby. With planning, many people with early-stage kidney disease or a stable transplant have healthy pregnancies. On dialysis the risks to parent and baby are high, and pregnancy is usually advised against (NKF).

Your numbers

Topic What the guidelines say Source
A1c before pregnancy Ideally under 6.5 % (48 mmol/mol), if it can be reached without significant lows ADA 2026 §15, recommendation 15.3
Contraception Use effective contraception until your treatment plan and A1c are ready for pregnancy ADA 2026 §15, 15.2
Blood pressure before pregnancy Under 140/90 mmHg on pregnancy-safe medicines UK Kidney Association, 3.3.4
After a transplant Wait at least 1 year, with stable kidney function and little protein in the urine KDIGO 2009, 25.2.1; UK Kidney Association, 5.1.1
Mycophenolate (for example CellCept) Must be stopped or switched before trying. The label requires acceptable birth control during treatment and for 6 weeks after stopping; UK guidance allows 3 months to switch and check that things are stable CellCept label, 8.3; UK Kidney Association, 2.5
Men taking mycophenolate The label recommends effective contraception during treatment and for at least 90 days after stopping, and no sperm donation CellCept label, 8.3
CKD stage G1–G2 with normal blood pressure and little protein: a healthy pregnancy is often possible. G3–G5: the risk of complications is much greater. Kidney failure: usually advised against NKF
Dialysis in pregnancy Longer, more frequent hemodialysis; people on PD are usually moved to hemodialysis UK Kidney Association, 5.2.2, 5.2.4

Mycophenolate REMS: in July 2026 the FDA ended the mycophenolate REMS program, but the label's warnings about miscarriage and birth defects, pregnancy testing and contraception still apply (FDA; REMS; CellCept label).

Sexual health

  • Problems with erections, desire, arousal or comfort are common with kidney disease and after a transplant, and many people do not mention them (KDIGO 2024, Figure 49; KDIGO 2009 transplant, 25.1.1).
  • Ask your kidney or diabetes team, or your transplant team; they should check for these problems after a transplant (KDIGO 2009 transplant, 25.1.1). Treatments exist.
  • After a transplant, your team should talk with you about sex, contraception and safe sex (KDIGO 2009 transplant, 25.1.2).

Medicines to review before pregnancy

KDIGO asks prescribers to check every medicine for risks to a baby, and to offer regular advice on contraception and pregnancy to anyone who could become pregnant (KDIGO 2024, practice point 4.1.4). With your prescribers, review:

  • ACE inhibitors and ARBs, the kidney-protecting blood pressure medicines. They can harm a baby, especially later in pregnancy. The ADA says to stop them before conception (ADA 2026 §15). UK kidney guidance says ARBs should be stopped before pregnancy, and that people with diabetic kidney disease may stay on an ACE inhibitor until conception, with regular pregnancy tests (UK Kidney Association, 3.3.5–3.3.6, 5.4.2). Your teams decide the timing together. Do not stop on your own: these medicines protect your kidneys.
  • Finerenone (Kerendia) and other MRAs: the ADA lists them with ACE inhibitors and ARBs as medicines to stop before conception; finerenone has not been studied in human pregnancy and harmed unborn animals (ADA 2026 §15, recommendation 15.25a; Kerendia label, section 8.1).
  • SGLT2 inhibitors, if you take one: the ADA lists them among kidney medicines not to use in pregnancy (ADA 2026 §11, recommendation 11.10).
  • GLP-1 receptor agonists (sometimes used for weight): the ADA says to stop them before pregnancy; semaglutide at least 2 months before (ADA 2026 §15).
  • Statins (cholesterol medicines): usually stopped before conception (ADA 2026 §15, recommendation 15.25b).
  • Mycophenolate and some other anti-rejection medicines: switched before pregnancy (KDIGO 2009, 25.2.2–25.2.3; UK Kidney Association, 2.4–2.5).
  • Every other medicine and supplement, including any new kidney or diabetes medicine.

What to do

  • If you could become pregnant, ask your teams about contraception that suits your medicines.
  • If you want a baby in the next year or two, say so now, so your teams can plan medicines, A1c, blood pressure and timing with you (UK Kidney Association, 3.3.1).
  • Ask for a referral to a maternal-fetal medicine specialist for pre-pregnancy counseling.
  • Ask how pregnancy might affect your kidneys, and what the risks are for you and the baby (UK Kidney Association, 3.3.2).
  • Ask whether you should use a CGM in pregnancy: the ADA recommends one for type 1 diabetes (ADA 2026 §15, 15.11).
  • If you are at stage 4–5 and thinking about pregnancy, ask about treatment options for kidney failure as well (UK Kidney Association, 3.3.7).
  • If you take an ACE inhibitor, ARB, finerenone, an SGLT2 inhibitor or mycophenolate and your period is late, take a pregnancy test and call your prescriber the same day.

Examples

Planning ahead. A 29-year-old woman with stage G2 CKD and type 1 diabetes wants a baby next year. She tells her teams. They agree a plan: contraception until her A1c is near target without lows, blood pressure under 140/90 on pregnancy-safe medicines, a decision about when to stop her ACE inhibitor, and a maternal-fetal medicine referral (ADA 2026 §15; UK Kidney Association).

After a transplant. A man takes mycophenolate after his transplant and he and his partner want a child. His transplant team explains the label's advice on contraception for male patients and plans with them (CellCept label).

An unplanned pregnancy. A woman on an ARB has a positive test. She does not stop anything on her own. She calls her nephrologist that day, who changes her medicines and refers her to maternal-fetal medicine (UK Kidney Association, 4.2.1, 4.2.5).

Ask your care team

  1. Which of my medicines are not safe in pregnancy, and what would replace them?
  2. Which contraception suits me with my medicines and my kidney function?
  3. What are the risks of pregnancy for my kidneys and for a baby at my stage?
  4. What should my A1c and blood pressure be before I try?
  5. Can you refer me to maternal-fetal medicine for pre-pregnancy counseling?
  6. Is there a treatment for my sexual problems that is safe with my kidneys?

Get help now if…

Call 911 (or your local emergency number)

Chest pain, severe breathlessness, a seizure, heavy bleeding, or a low the person cannot treat (give glucagon, then call). If you are pregnant, also follow the urgent advice your maternity team gives you. Full list: Get help now.

Call your team the same day

A positive pregnancy test while you take an ACE inhibitor, ARB, finerenone, an SGLT2 inhibitor, a GLP-1 receptor agonist, a statin or an anti-rejection medicine. Do not stop the medicine yourself; ask what to do.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.