Macrosomia is a risk factor for incident maternal chronic kidney disease

Gestational diabetes mellitus (GDM) and macrosomia are associated with several adverse outcomes including diabetes mellitus and cardiovascular diseases, however, the relationship between GDM/macrosomia with incident chronic kidney disease (CKD) is a matter of debate. The purpose of this study was to examine the association between the history of macrosomia with or without GDM and incident maternal CKD.

The study population includes 2669 women aged 18-50 years without known diabetes mellitus and CKD from participants of the Tehran Lipid and Glucose Study. The study population was categorized into 3 groups; group 1: GDM/macrosomia and without diabetes mellitus (n = 204), group 2: newly diagnosed incident diabetes mellitus (NDM) in the presence or abcence of GDM/Macrosomia (n = 113), and, group 3: the reference group including women without prior history of GDM/macrosomia and free of NDM (n = 2352). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m². Multivariable Cox proportional hazard regression adjusted for baseline values of age, body mass index, waist circumference, parity numbers, smoking, educational level, gestational hypertension, eGFR, systolic and diastolic blood pressures (SBP and DBP, respectively), anti-hypertensive medication, and family history of diabetes mellitus was applied for data analyses.

During a median follow-up of 11.9 years, 613 incident CKD cases were identified. The multivariable hazard ratio (HR) and 95% confidence interval (CI) on GDM/macrosomia group was [1.32 (1.02-1.72)]; the risk was more prominent among non-hypertensive women [1.41 (1.07-1.85); P for interaction: 0.046]. Moreover, the history of macrosomia alone also showed a significant risk [1.36 (1.04-1.78)]; however, history of GDM alone did not have a significant risk [0.92 (0.34-2.46)]. Age, current smoking, eGFR, and SBP remained as independent risk factors for incident CKD.

A history of GDM/macrosomia or macrosomia alone, independent of subsequent diabetes mellitus was associated with significant risk for incident maternal CKD. Pregnancy may provide a unique situation to identify high-risk women at risk for CKD that could benefit from regular monitoring of kidney function and providing risk modifying strategies.