Risk of Adverse Pregnancy Outcomes in Women with CKD

Abstract

CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (.1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P,0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.

Kidneys and women's health: key challenges and considerations

“…Perhaps most importantly, their kidney disease may impact on the health of future generations. Even CKD stage 1 is associated with an increased incidence of babies with growth-restriction, 24 which has a global impact on the child's organs, including their kidneys.…”

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“…CKD is a risk factor for adverse pregnancy outcomes from its early stages (Table I) (6,38,39). The risks increase from CKD stage 1 to CKD stage 5, and may be higher in glomerular nephropathies, autoimmune diseases, and diabetic nephropathy (6,7,(38)(39)(40)(41).…”

“…The risks increase from CKD stage 1 to CKD stage 5, and may be higher in glomerular nephropathies, autoimmune diseases, and diabetic nephropathy (6,7,(38)(39)(40)(41). Results of pregnancy after kidney donation suggest that reduction of kidney parenchyma may be associated with a higher risk of PE and hypertensive disorders of pregnancy (42,43).…”

“…Likewise, the effect of pregnancy on CKD progression is not fully understood because of different study designs, obstetric policies, and duration of follow-up. Overall, short-and long-term decrease in kidney function is unusual in early CKD, but the risk increases as CKD severity increases (6,7,(38)(39)(40)(41)(44)(45)(46)(47)(48).…”

Pregnancy and kidney disease: from medicine based on exceptions to exceptional medicine

“…The growing awareness of the importance of kidney diseases, beginning in their earliest, non-symptomatic phases, often associated with older age of women giving birth for the first time, and the increased use of assisted fertilisation techniques (often in older women) are factors that have increased the reported incidence and improved the diagnosis of chronic kidney diseases in pregnancy, especially in in the more developed nations [7,8].…”