Pregnant women who experience hypertensive disorders or deliver preterm are at increased risk for chronic kidney disease (CKD) and kidney failure later on, according to new research findings published in JAMA Network Open.

In a systematic review and meta-analysis of 23 studies involving 5,769,891 pregnant women, preeclampsia, gestational hypertension, and preterm deliveries were significantly associated with 4.9-, 3.6-, and 2.1-fold increased risks for end-stage renal disease (ESRD), respectively, compared with pregnant women without these conditions. Having preeclampsia preterm was associated with a 5.7-fold increased risk for kidney failure.

In addition, preeclampsia was significantly associated with 2.1- and 2.7-fold increased risks for CKD and kidney-related hospitalization, respectively. Gestational hypertension and gestational diabetes (the latter in black women only) were significantly associated with greater 1.5- and 1.8-fold increased risks of CKD, respectively.

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“Women who experience hypertensive disorders of pregnancy and other adverse pregnancy outcomes may warrant closer surveillance for long-term kidney disease,” Peter M. Barrett, MB, MSc, of University College Cork in Ireland and colleagues stated.

Preexisting hypertension, obesity, atherosclerosis, and/or endothelial damage possibly contribute. Undiagnosed nephropathy also cannot be ruled out.

“It is unclear whether adverse pregnancy outcomes unmask an existing predisposition toward kidney disease or induce endothelial or organ damage that alters a woman’s trajectory toward development of kidney disease,” the authors stated. “There is a need to optimize long-term follow-up of these women, and to implement preventive interventions that reduce their risk of developing clinically significant kidney disease.”

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Barrett PM, McCarthy FP, Kublickiene K, et al. Adverse pregnancy outcomes and long-term maternal kidney disease: A systematic review and meta-analysis [published online February 5, 2020]. JAMA Netw Open. 2020;3(2):e1920964. doi: 10.1001/jamanetworkopen.2019.20964