Pregnancy in chronic renal insufficiency: single centre experience from North India

Renal disease during pregnancy is relatively uncommon. The diagnosis of renal disease before or during pregnancy was only 0.03% in a population-based study of pregnant women with kidney disease. However, there is a paucity of scientific data regarding the general topic of renal disease in pregnancy on which to base clinical management and counselling recommendations.

A retrospective analysis of 14 year period was carried out in a referral hospital in northern India. Pregnant women were analyzed with respect to degree of renal impairment for the effect of renal disease on course of pregnancy, complications during pregnancy and perinatal outcome.

Outcome of 30 pregnancies (29 women) was available during the study period of 14 years. Pregnancy outcome was comparable in all types of glomerulonephritis. Progression of the disease during pregnancy was observed in total six patients. Proteinuria was in the range of 800 mg/day to 6.2 g/day (2.802 +/- 1.519 g/day). Anemia was identified in 12(46.1%) and 3(7.7%) required multiple blood transfusions. Twenty-four (90%) women developed hypertension during pregnancy. Mild hypertension was seen in 40% patients and, 43.3% had severe hypertension requiring drug therapy. Obstetrical complications included a high frequency of preterm delivery (85%) and caesarean section (30%). Overall fetal survival rate was 77%.

Most women with chronic renal disease will have a successful outcome if they receive proper prenatal care. Pregnant women with moderate or severe renal insufficiency have increased rates of complications due to worsening renal function, hypertension, and other obstetrical complications, but fetal survival is high.