Pregnant Stone Formers Have Higher Risk of Gestational Diabetes

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Pregnant women with vs without a history of nephrolithiasis are more likely to experience gestational diabetes and preeclampsia.
Pregnant women with vs without a history of nephrolithiasis are more likely to experience gestational diabetes and preeclampsia.

Women with a history of kidney stone formation are at elevated risk of gestational diabetes and preeclampsia, new findings suggest.

In a retrospective cohort study of women who delivered infants at Massachusetts General Hospital in Boston from 2006 to 2015, investigators found that gestational diabetes and preeclampsia occurred significantly more frequently among stone formers than women without a history of stone formation (18% vs 6%, respectively, and 16% vs 8%, respectively). In multivariable analysis, prior nephrolithiasis was associated with a significant 3.1-fold higher odds of gestational diabetes and 2.2-fold higher odds of preeclampsia.

Additionally, infants of stone formers were born significantly earlier (38.7 vs 39.2 weeks). The rates of small for gestational age offspring and neonatal intensive care admission were not significantly between stone formers and non-stone formers (8% and 7%, respectively, and 10% and 6%, respectively).

“In conclusion, our findings show that a history of kidney stones identifies women at higher risk for metabolic and hypertensive complications in pregnancy,” Jessica Sheehan Tangren, MD, of Massachusetts General, and colleagues reported online ahead of print in the Clinical Journal of the American Society of Nephrology. “This finding supports the link between stone disease, diabetes, and hypertension and identifies a new population that may be differentially affected by stone disease.”

The study included 166 stone formers and 1264 women without a history of stone formation. None of the patients had preexisting diabetes, hypertension, and chronic kidney disease. Women in both groups had a mean age of 32 years at their first prenatal visit. The investigators defined gestational diabetes as a 1-hour glucose load test value greater than 140 mg/dL and 2 abnormal values on a 3-hour 100-g glucose tolerance test using Carpenter-Coustan criteria. They defined preeclampsia on the basis of blood pressure and spot urine protein measurements made at prenatal visits.

“Pregnancy offers a unique window to study both metabolic and cardiovascular risks in women,” the authors wrote. “During pregnancy, there are dramatic alternations in maternal metabolism and systemic hemodynamics that are important for fetal development. These changes may unmask subclinical disease in women.”

Previous studies have found links between nephrolithiasis during pregnancy and adverse outcomes. A retrospective population-based study by investigators at Ben Gurion University of the Negev in Be'er-Sheva, Israel, found that maternal kidney stones are significantly associated with gestational diabetes, hypertensive disorders, and recurrent abortions, according to findings published in the World Journal of Urology (2011;29:743-747). A study published in Obstetrics & Gynecology (2007;109:1099-1104) found that pregnant women hospitalized for kidney stones have a nearly 2-fold increased risk of preterm delivery compared with women without kidney stones.

Reference

Tangren JS, Powe CE, Ecker J, et al. Metabolic and hypertensive complications of pregnancy in women with nephrolithiasis. Clin J Am Soc Nephrol. 2018;13. Doi. https://doi.org/10.2215/CJN.12171017

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