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Impact of pre-conception kidney function on pregnancy outcomes
Laura Cuthbertson1,2, Erandi Hewawasam3,4, Alex Kitsos5
1Department of Nephrology, St Vincent's Hospital Melbourne, Victoria, Australia.
Summary
Early-stage chronic kidney disease (CKD) in pregnancy increases risks for hypertension, preeclampsia, low birth weight, and preterm delivery. Preconception kidney function assessment is crucial for managing these risks.
Area of Science:
- Obstetrics and Gynecology
- Nephrology
- Public Health
Background:
- The impact of early chronic kidney disease (CKD) on pregnancy outcomes is not well understood.
- Identifying women with suspected early CKD before conception is essential for assessing maternofoetal risks.
Purpose of the Study:
- To identify women with suspected early CKD preconception.
- To evaluate the impact of early CKD on maternofoetal outcomes during pregnancy.
Main Methods:
- Linked statewide perinatal, pathology, renal registry, and administrative datasets (2005-2023).
- Included women aged ≥18 years with maternal serum creatinine measures within 5 years preconception or <30 days post-conception.
- Examined maternofetal outcomes in relation to estimated glomerular filtration rate (eGFR) and kidney disease diagnoses.
Main Results:
- 1 in 10 pregnancies involved women with eGFR <90 mL/min/1.73m², proteinuria, or diagnosed kidney disease.
- Women with suspected early CKD had increased risks of gestational hypertension (OR 1.21), preeclampsia (OR 1.26), low birth weight (OR 1.15), and preterm delivery (OR 1.27).
- Only 6% of women with eGFR <90 mL/min/1.73m² had quantitative albuminuria or proteinuria measurements preconception.
Conclusions:
- Preconception assessment of kidney function is warranted, as 1 in 10 pregnancies are affected by early CKD.
- While women with early CKD face elevated risks for certain maternofetal complications, the overall absolute risk is small.
- Further research should focus on preconception kidney function screening and management strategies.
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