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Pre-Pregnancy eGFR and the Risk of Adverse Maternal and Fetal Outcomes: A Population-Based Study
Jessica Tangren1, Lavanya Bathini2, Nivethika Jeyakumar3
1Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical Center, Boston, Massachusetts.
Journal of the American Society of Nephrology : JASN
|February 3, 2023
Summary
Pregnancies in women with chronic kidney disease (CKD) show increased risks for adverse outcomes, especially with lower estimated glomerular filtration rate (eGFR) and proteinuria. These findings highlight the need for informed preconception counseling and pregnancy management in this population.
Area of Science:
- Nephrology
- Obstetrics
- Public Health
Background:
- Chronic kidney disease (CKD) is a known risk factor for pregnancy complications.
- Existing data on adverse pregnancy outcomes in CKD often come from small, single-center studies, particularly lacking information on advanced CKD stages.
Purpose of the Study:
- To investigate the association between maternal baseline estimated glomerular filtration rate (eGFR) and the risk of adverse pregnancy outcomes.
- To assess the impact of proteinuria on these risks in women with CKD.
Main Methods:
- Retrospective, population-based cohort study in Ontario, Canada (2007-2019).
- Included 565,907 pregnancies among 462,053 women without dialysis or kidney transplant.
- Utilized administrative health databases for births, lab results, and complications; analyzed serum creatinine and urine protein levels.
Main Results:
- Adverse maternal and fetal outcomes (major morbidity, preterm delivery, low birthweight) increased with declining eGFR, most notably below 60 ml/min per 1.73 m².
- Preterm delivery occurred in 40% of pregnancies with eGFR <45 ml/min per 1.73 m², versus 10% with eGFR >90 ml/min per 1.73 m².
- Proteinuria significantly elevated risks across all eGFR categories; maternal/neonatal deaths were rare.
Conclusions:
- Higher rates of adverse pregnancy outcomes are linked to low eGFR and concurrent proteinuria in women with CKD.
- Findings can inform health care policy, preconception counseling, and pregnancy follow-up strategies.
- Emphasizes the importance of assessing both eGFR and proteinuria for risk stratification.
