Pregnancy in CKD Stages 3 to 5: Fetal and Maternal Outcomes

Imbasciati, E; Gregorini, Gina; Cabiddu, Gianfranca; Gammaro, Linda; Ambroso, G; Giudice, Antonio Del; Ravani, Pietro

doi:10.1053/j.ajkd.2007.03.022

Cited by 238 publications

(157 citation statements)

References 14 publications

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“…However, in this large multicenter series the time span of enrollment was wider (1977 to 2004), and recent changes in the global care of the CKD patients as well as changing policies toward delivery may have played an important role. For example, their series reports a higher prevalence of SGA babies and a lower prevalence of prematurity as compared with ours, probably reflecting a different policy toward delivery in case of flattening of the growth curve (10).…”

Section: Discussioncontrasting

confidence: 55%

“…The prevalence of stillbirth, neonatal, and perinatal deaths reported in papers dealing with at least 25 pregnancies reaches 8% to 15% in different subgroups (8,9,14,22,23,28) and is in the range of 1% to 7% in most series (10,13,19,20,26,27,32); a few maternal deaths are reported (all in lupus patients) related to disease flare-ups (14,23,27). that retrieved 83 and 101 cases with CKD, respectively, the prevalence of live birth was significantly associated with a cutoff of maternal serum creatinine at 1.1 mg/dl.…”

Section: Discussionmentioning

confidence: 99%

“…The review of 25 studies dealing with at least 25 pregnancies published in English in the last 10 years (8 -32) revealed heterogeneous definitions and classifications of CKD: the categories are mostly based on serum creatinine, but the cut points are different (20,29,31); a few studies use GFR, but cut points are seldom the same, thus adding to the dispersion of the results (10). Within these limits and taking into account the different diseases considered, prematurity ranges from 5% to 100%, low birth weight rates range from 2% to 60%, and fetal death rates been in a dedicated outpatient unit.…”

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confidence: 99%

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Pregnancy and Chronic Kidney Disease

Piccoli

Attini

Vasario

et al. 2010

Clinical Journal of the American Society of Nephrology

185

158

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Background and objectives: Chronic kidney disease (CKD) is a challenge for pregnancy. Its recent classification underlines the importance of its early phases. This study's aim was to evaluate outcomes of pregnancy according to CKD stage versus low-risk pregnancies followed in the same center.Design, setting, participants, & measurements: The prospective analysis was conducted from January 2000 to May 2009 with the start of observation at referral and end of observation 1 month after delivery. Ninety-one singleton deliveries were studied; 267 "low-risk" singleton pregnancies served as controls. Because of the lack of hard end points (death, start of dialysis), surrogate end points were analyzed (cesarean section, prematurity, neonatal intensive care).Results: CKD outcome was worse than physiologic pregnancies: preterm delivery (44% versus 5%); cesarean section (44% versus 25%); and need for neonatal intensive care (26% versus 1%). The differences were highly significant in stage 1 CKD (61 cases) versus controls (CKD stage 1: cesarean sections ‫؍‬ 57%, preterm delivery ‫؍‬ 33%, intensive care ‫؍‬ 18%). In CKD, proteinuria and hypertension were correlated with outcomes [proteinuria dichotomized at 1 g/24 h at referral: need for intensive care, relative risk (RR) ‫؍‬ 4. Conclusions: CKD is a challenge for pregnancy from early stages. Strict follow-up is needed for CKD patients, even when there is normal renal function.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pregnancy and Chronic Kidney Disease

Piccoli

Attini

Vasario

et al. 2010

Clinical Journal of the American Society of Nephrology

185

158

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“…The interaction between placental development, renal hyperfiltration, increase in proteinuria, and development of pregnancy-related hypertensive disorders is still not fully understood (16)(17)(18)(19)(20). Because of their teratogenicity, the need to discontinue drugs that act on the renin-angiotensin system complicates the management of proteinuric patients (44,45).…”

Section: Discussionmentioning

confidence: 99%

“…Despite heterogeneous medical literature, the overall risk of delivering small children parallels CKD progression (16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Piccoli¹,

Leone²,

Attini

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Women affected by CKD increasingly choose to get pregnant. Experience with lowprotein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets.Design, setting, participants, & measurements This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (.1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies-21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 proteinunrestricted meals allowed per week.Results Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P,0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups.Conclusion Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.

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Renal disease

Jeyabalan

2018

Evidence‐based Obstetrics and Gynecology

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Pregnancy in CKD Stages 3 to 5: Fetal and Maternal Outcomes

Cited by 238 publications

References 14 publications

Pregnancy and Chronic Kidney Disease

Pregnancy and Chronic Kidney Disease

Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Renal disease

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