Chronic kidney disease (CKD) can profoundly impact women’s fertility and options for pregnancy.1,2 Maternal risks during pregnancy include accelerated hypertension, kidney disease progression, premature initiation of dialysis, and preeclampsia.3 Fetal risks include intrauterine growth restriction, preterm delivery, small for gestational age, spontaneous abortion, or perinatal death. Risks increase with more advanced kidney disease, hypertension, or proteinuria,4 and medications used to treat CKD are often contraindicated in pregnancy.