Kidney Disease Linked to Worse Pregnancy, Fetal Outcomes

Women with kidney disease who want to become pregnant should have preconception counseling.
Women with kidney disease who want to become pregnant should have preconception counseling.

Kidney disease in pregnant women is independently associated with adverse maternal and fetal outcomes, including delivery of preterm and low-birth-weight infants, new study findings suggest.

“Considering the potential for adverse outcomes, women with kidney disease who want to become pregnant should have preconception counseling,” the study's authors concluded in the American Journal of Kidney Diseases (published online ahead of print). “Our results should aid the health care provider in counseling women with kidney disease about pregnancy. A multidisciplinary approach involving obstetricians and nephrologists is needed in order to improve pregnancy outcomes in women with kidney disease.”

Jessica Kendrick, MD, MPH, of the University of Colorado Denver, Aurora, and colleagues studied 1,556 women admitted to the Intermountain Healthcare system for childbirth. The group included 778 women with kidney disease who were matched by race and history of diabetes, chronic hypertension, liver disease, and connective tissue disease to 778 women without kidney disease. The 2 group were “near-matched” (within 2 years) by age.

Compared with women who did not have kidney disease, those with kidney disease had 52% increased odds of preterm delivery and 33% increased odds of delivery by cesarean section, Dr. Kendrick's group reported. Infants born to women with kidney disease had 71% increased odds of admission to the neonatal intensive care unit or infant death compared with infants born to mothers without kidney disease. Additionally, kidney disease was associated with 2.3 times increased odds of low birth weight (less than 2,500 grams). The study showed no increased risk of maternal death associated with kidney disease.

“This study demonstrates that adverse maternal and fetal outcomes remain high in women with kidney disease notwithstanding advances in obstetric and neonatal care. … To our knowledge, this is the first study to show that kidney disease is associated with adverse maternal and fetal outcomes after matching pregnant women with and without kidney disease for significant comorbid conditions,” the authors wrote.

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