Chronic kidney disease and adverse pregnancy outcomes: a systematic review and meta-analysis

Khalaf, Sukainah Al; Bodunde, Elizabeth O; Maher, Gillian M.; O’Reilly, Éilis J.; McCarthy, Fergus P.; O’Shaughnessy, Michelle M.; O’Neill, Sinéad M; Khashan, Ali S.

doi:10.1016/j.ajog.2021.10.037

Cited by 31 publications

(30 citation statements)

References 44 publications

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“…The high frequency of a previous history of pre-eclampsia in kidney recipients [ 17 , 18 , 19 ] and the knowledge of a short life expectancy in lung recipients affected by cystic fibrosis might explain this fear. Consistent with many published studies [ 9 , 20 , 21 ], the importance of multidisciplinary counseling for SOT patients planning pregnancy cannot be over-emphasized and was performed on more than 70% of the pregnancies in our survey.…”

Section: Discussionmentioning

confidence: 99%

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Bedin

Carbonnel

Snanoudj

et al. 2022

JCM

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In recent years, solid organ transplantations, such as kidney or lung grafts, have been performed worldwide with an improvement of quality of life under immunosuppressive therapy and an increase in life expectancy, allowing young women to consider childbearing. In the current study, we conduct a retrospective study in two French centers for kidney and lung transplantations to evaluate the rate and outcomes of pregnancies, contraception and gynecological monitoring for women under 40 years old who underwent solid organ transplantation. Among 210 women, progestin was the most widely used contraceptive method. Of the 210 women, 24 (11.4%) conceived 33 pregnancies of which 25 (75.8%) were planned with an immunosuppressant therapy switch. Of the 33 pregnancies, 7 miscarried (21.2%) and 21 (63.7%) resulted in a live birth with a high rate of pre-eclampsia (50%). No graft rejections were observed during pregnancies. Among the deliveries, 19 were premature (90.5%, mostly due to induced delivery) and the C-section rate was high (52.4%). No particular pathology was identified among newborns. We conclude that pregnancies following solid organ transplantation are feasible, and while they are at an increased risk of pre-eclampsia and prematurity, they should still be permitted with close surveillance by a multidisciplinary care team.

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Section: Discussionmentioning

confidence: 99%

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Bedin

Carbonnel

Snanoudj

et al. 2022

JCM

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“…Beyond the traditional CVH metrics, chronic kidney disease is an important risk factor for APOs and long-term CVD in birthing individuals. 49…”

Section: Associations Between Prepregnancy Cvh and Aposmentioning

confidence: 99%

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association

Khan¹,

Brewer²,

Canobbio³

et al. 2023

Circulation

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This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.

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“…Chronic physical conditions such as hypertension, kidney disease, systemic lupus erythematosus and abnormal pre-pregnancy BMI are associated with adverse perinatal outcomes. 20–23 46 47 Our findings also indicated that multimorbidity might alter the risk of PTB, LBW and SGA depending on whether multimorbidity included or did not include abnormal BMI. Additionally, maternal infections, such as HIV, malaria, syphilis and tuberculosis, have been reported to be associated with adverse perinatal outcomes.…”

Section: Discussionmentioning

confidence: 52%

“…It has been widely known that maternal physical morbidity such as hypertension, kidney disease and systemic lupus erythematosus increase the risk of preterm births (PTBs) and low birthweight (LBW) infants. [20][21][22][23] Moreover, maternal psychological and social morbidity have been also associated with PTB and LBW. [24][25][26][27][28][29] In their review, McCauley et al were trying to assess the impact of each type of morbidity on women's health and wellbeing during pregnancy and after childbirth; however, a meta-analysis of the associations between multimorbidity and obstetrical complications could not be performed because of the heterogeneity of each study.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Association between maternal multimorbidity and preterm birth, low birth weight and small for gestational age: a prospective birth cohort study from the Japan Environment and Children’s Study

et al. 2023

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ObjectivesMultimorbidity is defined as the coexistence of two or more chronic physical or psychological conditions within an individual. The association between maternal multimorbidity and adverse perinatal outcomes such as preterm delivery and low birth weight has not been well studied. Therefore, this study aimed to investigate this association.MethodsWe conducted a prospective cohort study using data from the Japan Environment and Children’s Study of pregnant women between 2011 and 2014. Those with data on chronic maternal conditions were included in the study and categorised as having no chronic condition, one chronic condition or multimorbidities. The primary outcomes were the incidence of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). Adjusted logistic regression was performed to estimate ORs (aORs) and 95% CIs.ResultsOf the 104 062 fetal records, 86 885 singleton pregnant women were analysed. The median maternal age and body mass index were 31 years and 20.5 kg/m2, respectively. The prevalence of pregnant women with one or more chronic conditions was 40.2%. The prevalence of maternal multimorbidity was 6.3%, and that of PTB, LBW, and SGA were 4.6%, 8.1%, and 7.5%, respectively. Pre-pregnancy underweight women were the most common, observed in 15.6% of multimorbidity cases, followed by domestic violence from intimate partner in 13.0%. Maternal multimorbidity was significantly associated with PTB (aOR 1.50; 95% CI 1.33–1.69), LBW (aOR 1.49; 95% CI 1.35–1.63) and SGA (aOR 1.33; 95% CI 1.20–1.46).ConclusionMaternal multimorbidity was associated with adverse perinatal outcomes, including PTB, LBW and SGA. The risk of adverse perinatal outcomes tends to increase with a rise in the number of chronic maternal conditions. Multimorbidity becomes more prevalent among pregnant women, making our findings important for preconception counselling.

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Chronic kidney disease and adverse pregnancy outcomes: a systematic review and meta-analysis

Cited by 31 publications

References 44 publications

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association

Association between maternal multimorbidity and preterm birth, low birth weight and small for gestational age: a prospective birth cohort study from the Japan Environment and Children’s Study

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