Health Care Utilization Among Pregnant Women With Pre-existing Kidney Disease: A Retrospective Cohort Analysis

Pregnant women with prepregnancy chronic kidney disease (CKD) are underdiagnosed and experience adverse outcomes. Limited research exists on peripregnancy health care utilization by women with evidence of CKD.

Retrospective cohort analysis.

Women with laboratory signs of prepregnancy CKD who had a pregnancy event between January 1, 2016, and March 1, 2023, at Montefiore Health System in Bronx, NY, were included.

We investigated rates of CKD diagnosis, adverse maternal and fetal outcomes, and peripregnancy health care utilization among a sample of women with evidence of prepregnancy CKD.

We tested the proportion of women with laboratory signs of CKD who had a diagnosis code for CKD entered on their problem list. We also examined the association of different eGFR/proteinuria cutoffs among the cohort with (1) adverse pregnancy outcomes, (2) postpregnancy CKD prevalence, and (3) peripregnancy health utilization.

Of the 247 pregnant women who met criteria for prepregnancy CKD by estimated glomerular filtration rate (eGFR) or proteinuria, 8.1% had spontaneous abortion, 10.9% had missed abortion, 12.9% had CKD listed in problem list. Out of 80.9% of pregnancy that reached fetal viability, 12.5% had early preterm delivery, 22.6% developed gestational hypertension, and 20.0% of their infants required neonatal intensive care unit admission, with worse outcomes seen in those with severe CKD (defined as eGFR < 45 mL/min/1.73 m² or proteinuria > 1,000 mg/g). Among women with CKD, 27.6% were seen by primary care within 1 year before pregnancy while less than 0.1% were ever seen by a nephrologist. Among women with severe CKD, only 40% were seen by nephrology during pregnancy, and less than 50% had a nephrology appointment arranged at discharge.

Retrospective analysis of a single-center data source.

Pregnant women with CKD were frequently underdiagnosed and not sufficiently integrated into care before, during, or after pregnancy.