The association between maternal renal function and pregnancy outcomes in type 1 and type 2 diabetes

Seah, Jas-Mine; Kam, Ning M.; Wong, Lo; Tanner, Cara; MacIsaac, Richard J; Shub, Alexis; Ekinci, Elif I; Houlihan, Christine

doi:10.1016/j.diabres.2020.108225

Cited by 4 publications

(15 citation statements)

References 17 publications

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“…Pre-eclampsia was commonly reported, ranging from 0% 12 in one subgroup of 10 women with microalbuminuria to 64% (IQR 33.3-42.5%); 17 compared to healthy women, women with diabetic kidney disease were more likely to develop pre-eclampsia (OR 5.5 (2.5 to 11.8)). 13 One study which included diabetic women without albuminuria, with microalbuminuria and macroalbuminuria reported pre-eclampsia in 6%, 42% and 64%, respectively. 14 Caesarean section was the most common method of delivery, ranging from 20% to 100% (IQR 69.2-90.0).…”

Section: Baseline Characteristics (mentioning

confidence: 99%

“…One study divided participants into subgroups based on their renal function 10 and four divided them into subgroups based on micro-or macroalbuminuria. [11][12][13][14] Seven studies included controls, either diabetic or non-diabetic pregnant women or women with DKD who did not have a pregnancy. Study heterogeneity was significant, precluding the pooling of data and meta-analysis.…”

Section: Study Selection and General Information (Table 1)mentioning

confidence: 99%

“…Study heterogeneity was significant, precluding the pooling of data and meta-analysis. 1970-1985 1982-1991 1990-1993 1982-1992 1988-1994 1983-1985 1985-1993 1978-1991 1981-1993 1984-1996 1984-1990 1990-1995 1982-1996 1990-1997 1985-1993 1996 Combs, 1993 20 Hod, 1995 21 Kimmerle, 1995 4 Gordon, 1996 22 Kaaja, 1996 23 Mackie, 1996 10 Miodovnik, 1996 24 Purdy, 1996 25 Zhu, 1997 26 Reece, 1998 27 Bar, 1999 28 Biesenbach, 1999 11 Dunne, 1999 29 Biesenbach, 2000 30 Ekbom, 2001 14 9 Rossing, 2002 18 Bagg, 2003 31 Carr, 2006 7 Nielson, 2006 32 Nielsen, 2009 12 Yogev, 2009 33 Jensen, 2010 34 Bell, 2012 17 Young, 2012 35 Damm, 2013 5 Piccoli, 2013 15 Klemetti, 2015 16 Seah, 2020 13 DN, diabetic nephropathy; Cr, creatinine Reece, 1990 19 Combs, 1993 20 Hod, 1995 21 Kimmerle, 1995 4 Gordon, 1996 22 Kaaja, 1996 23 Mackie, 1996 10 Moderate renal impairment Mild renal impairment Miodovnik, 1996 24 Purdy, 1996 25 Zhu, 1997 26 Reece, 1998 27 Bar, 1999…”

Section: Study Selection and General Information (Table 1)mentioning

confidence: 99%

“…Seah, 2020 13 REVIEW with DKD experiencing 873 pregnancies. The mean age ranged from 24 to 34 years and the mean duration of diabetes ranged from 2 years (in two subgroups with type 2 diabetes) 11 to 22.6 years.…”

Section: Baseline Characteristics (mentioning

confidence: 99%

“…15 Compared with healthy women, DKD was associated with premature delivery (microalbuminuria OR 3.9 (1.5 to 9.90), macroalbuminuria OR 3.9 (1.5 to 9.9)). 13 One study which included diabetic women with no albuminuria, with microalbuminuria and macroalbuminuria reported premature delivery in 35%, 62% and 91%, respectively. 12 Very premature births, variably reported as before 32 or 34 weeks, occurred in 0-46% of births (IQR 9.4-38.6).…”

Section: Baseline Characteristics (mentioning

confidence: 99%

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Diabetic kidney disease and pregnancy outcomes: a systematic review

2021

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Introduction: We systematically reviewed all relevant literature on diabetic kidney disease (DKD) and pregnancy published in the last 20 years to provide accurate and up-to-date information to inform family planning and maternal care. Methods: A systematic review was completed in PubMed and Embase. Papers reporting maternal, fetal or renal outcomes of pregnant women with DKD published between 2001 and 2020 were included. Results: 799 potentially relevant articles were identified, 731 of which were excluded on abstract alone. 68 full-text articles were reviewed and 15 papers were included as they met the selection criteria but were heterogeneous for size, study setting and years studied. The definition of DKD varied between papers and changed over time. 843 women with 873 pregnancies were included. There were high rates of pre-eclampsia and caesarean section, up to 64% and 100% respectively. Prematurity and neonatal intensive care admission were common, reported in up to 100% and 75%, respectively. Maternal and fetal complications were more common with more severe proteinuria and renal impairment. Pregnancy did not hasten progression of DKD. Discussion: Adverse pregnancy outcomes are frequently encountered and correlate with degree of proteinuria and renal impairment. This information enables individualised risk stratification when a woman is considering pregnancy.

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Section: Baseline Characteristics (mentioning

confidence: 99%

Section: Study Selection and General Information (Table 1)mentioning

confidence: 99%

Section: Study Selection and General Information (Table 1)mentioning

confidence: 99%

Section: Baseline Characteristics (mentioning

confidence: 99%

Section: Baseline Characteristics (mentioning

confidence: 99%

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Diabetic kidney disease and pregnancy outcomes: a systematic review

2021

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

Khalaf

Bodunde

Maher

et al. 2022

American Journal of Obstetrics and Gynecology

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Adverse pregnancy outcomes in pregnant women with chronic kidney disease: A systematic review and meta‐analysis

Jeyaraman,

Walters,

Bramham

et al. 2024

BJOG

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BackgroundChronic kidney disease (CKD) is associated with an increased risk of adverse pregnancy outcomes, but the risk at different stages of CKD (defined by estimated glomerular filtration rate, eGFR) compared with women without CKD has not been quantified in large cohorts.ObjectivesTo quantify the association between CKD and adverse pregnancy outcomes according to CKD definition, CKD stage and presence or absence of diabetes.Search strategyA systematic search of EMBASE and MEDLINE from inception to 5 January 2023.Selection criteriaEnglish‐language randomised controlled trials as well as cohort and case–control studies investigating adverse pregnancy outcomes in pregnant women with CKD.Data collection and analysisTwo reviewers conducted independent data extractions. A random‐effects model was used to estimate risk.Main resultsWe included 19 studies with 3 251 902 women. Defining CKD using eGFR or serum creatinine produced results with greater effect size but wider confidence intervals. Compared with CKD stages 1–2, women with CKD stages 3–5 have a greater risk, but also greater imprecision in the risk estimate, of the following outcomes: pre‐eclampsia (OR 55.18, 95% CI 2.63–1157.68, vs OR 24.74, 95% CI 1.75–348.70), preterm birth (OR 20.24, 95% CI 2.85–143.75, vs OR 8.18, 95% CI 1.54–43.46) and neonatal intensive care unit admission (OR 19.32, 95% CI 3.07–121.68, vs OR 9.77, 95% CI 2.49–38.39). Women with diabetic kidney disease, compared with women without diabetic kidney disease, have higher risks of maternal mortality, small‐for‐gestational‐age neonates, pre‐eclampsia and gestational hypertension.ConclusionsThere is heterogeneity in the definition of CKD in pregnancy. Future studies should consider ways to standardise its definition and measurement in pregnancy.

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The association between maternal renal function and pregnancy outcomes in type 1 and type 2 diabetes

Cited by 4 publications

References 17 publications

Diabetic kidney disease and pregnancy outcomes: a systematic review

Diabetic kidney disease and pregnancy outcomes: a systematic review

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

Adverse pregnancy outcomes in pregnant women with chronic kidney disease: A systematic review and meta‐analysis

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