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Fitzpatrick A, Venugopal K, Scheil W, McDonald SP, Jesudason S: The Spectrum of Adverse Pregnancy Outcomes Based on Kidney Disease Diagnoses: A 20-Year Population Study. Am J Nephrol DOI 10.1159/000499965
Complications of pregnancy (e.g. hypertension, premature birth, intra-uterine growth retardation, urgent C-section, etc.) are generally believed to be associated (in a likely causal manner) with the presence of kidney disease preceding pregnancy.
In a descriptive, retrospective analysis of singleton pregnancies (n=407,580 births) over 20 years (1990–2012) in South Australia, Fitzpatrick and co-workers analysed the frequency and characteristics of kidney disease. Kidney disease was identified in 1392 pregnancies or 0.3% of the total. The presence of kidney disease was associated with an increased risk of pregnancy induced hypertension, urgent C-section, premature birth, low birth weight, prematurity and admissions of the neonate to an Intensive Care Unit. The nature of the underlying kidney disease could only be partially characterized due to data limitations. Vesico-ureteric reflux nephropathy and immunological kidney disease (mainly glomerulonephritis) were particularly associated with adverse maternal/fetal outcomes.
Such population level data is of interest as the findings may guide preventatives measures, such as early recognition and treatment of pre-eclampsia. Interestingly, in this group of subjects, low birth weight was primarily a function of premature delivery, rather than intra-uterine growth retardation. Renal function parameters could not be assessed in this analysis, so chronic kidney disease (CKD) stage could not be determined – a significant weakness. Nevertheless, pregnancy with concomitant kidney disease warrants careful monitoring and attempts to ameliorate the risks of complications.
