Chronic Kidney Disease May Increase Certain Risks During Pregnancy

Highlights• Among pregnant women, the risk for adverse pregnancy outcomes—such as preterm delivery or the need for neonatal intensive care—increased across stages of chronic kidney disease.• The risks of intrauterine death or fetal malformations were not higher in women with chronic kidney disease.An estimated 26 million people in the United States have chronic kidney disease.

Newswise — Washington, DC (March 12, 2015) — Even mild kidney disease during pregnancy may increase certain risks in the mother and baby, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings may be helpful for guiding prenatal counseling and for monitoring women during pregnancy.

Chronic kidney disease (CKD) is on the rise, and studies suggest that even early stages of the disease can affect pregnancy outcomes. An Italian research team led by Giorgina Barbara Piccoli, MD, Rossella Attini, MD, PhD (University of Torino), and Gianfranca Cabiddu, MD (Azienda Ospedaliera Brotzu) recently conducted a study—called the TOCOS (TOrino-Cagliari Observational Study)—that compared pregnancy outcomes of504 pregnancies in women with CKD with outcomes of 836 low-risk pregnancies in women without CKD.

The researchers found that the risk for adverse pregnancy outcomes—such as preterm delivery, the need for neonatal intensive care, or the development of hypertension in the mother—increased across CKD stages. However, the risk was not merely linked to reduced kidney function because stage 1 CKD patients and healthy controls differed significantly, despite the fact that patients with stage 1 CKD are asymptomatic and have kidney function within the normal range. The team also found that the risks of intrauterine death or fetal malformations did not differ between patients and healthy controls.

“The findings indicate that any kidney disease—even the least severe, such as a kidney scar form a previous episode of kidney infection, with normal kidney function—has to be regarded as relevant in pregnancy, and all patients should undergo a particularly careful follow-up,” said Dr. Piccoli. “Conversely, we also found that a good outcome was possible in patients with advanced CKD, who are often discouraged to pursue pregnancy,” she added.

The investigators hope that the new findings may help establish dedicated programs for the early diagnosis and follow up of pregnancy in CKD. “We are presently working on a model for ‘grading’ the risks that will provide patients and physicians with information when making choices about undergoing and monitoring pregnancies,” said Dr. Piccoli.

Study co-authors include Federica Vigotti, MD, Stefania Maxia, MD, Nicola Lepori, MD, Milena Tuveri, MD, Marco Massidda, MD, Cecilia Marchi, MD, Silvia Mura, MD, Alessandra Coscia, MD, Marilisa Biolcati, PhD, Pietro Gaglioti, MD, Michele Nichelatti, PhD, Luciana Pibiri, MD, Giuseppe Chessa, MD, Antonello Pani, MD, and Tullia Todros, MD, PhD.

Disclosures: The authors reported no financial disclosures.

The article, entitled “Risk of Adverse Pregnancy Outcomes in Women with CKD,” will appear online at http://jasn.asnjournals.org/ on March 12, 2015. The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.Founded in 1966, and with more than 15,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.