Maternal kidney disease and composite kidney outcomes in the offspring

Maternal chronic kidney disease (CKD) is associated with adverse pregnancy outcomes, but its relationship with long-term offspring kidney health remains uncertain. This retrospective maternal-child cohort study examined whether maternal CKD or reduced kidney function before or during pregnancy was associated with a composite kidney outcome in offspring. Live births in the Taiwan Mother and Child Health cohort from 2007 to 2017 were followed through 2018. In the primary cohort, maternal kidney disease was defined as claims-based CKD meeting chronicity criteria before or during pregnancy; the maternal eGFR subcohort additionally included eGFR-defined reduced kidney function. The primary outcome comprised ICD-defined CKD, reduced eGFR <60 mL/min/1.73 m² or ≥30% eGFR decline at age ≥2 years, or kidney replacement therapy. Laboratory components were interpreted as reduced kidney function rather than definitive CKD unless diagnostic chronicity was documented. Models adjusted for maternal, pregnancy, offspring, and perinatal covariates. Among 79,036 children, 4,687 (5.9%) met the composite kidney outcome. Maternal kidney disease was associated with modestly higher odds of the composite outcome (aOR, 1.29; 95% CI, 1.00-1.66) and offspring all-cause mortality (aOR, 1.88; 95% CI, 1.15-3.09). Analyses of individual components of the composite outcome, sex-stratified subgroups, and trimester-specific exposure windows were exploratory, imprecise, and not adjusted for multiplicity. Maternal CKD or reduced kidney function may identify dyads who warrant long-term kidney surveillance, although causal pathways require confirmation.