title: Pregnancy outcomes in women with chronic kidney disease: a systematic review.
abstract: OBJECTIVE
  Pregnant women with chronic kidney disease (CKD) are at risk of adverse maternal and fetal outcomes. We conducted a systematic review of observational studies that described this risk.
  
  
  METHODS
  We searched several databases from their date of inception through June 2010 for eligible articles published in any language. We included any study that reported maternal or fetal outcomes in at least five pregnant women in each group with or without CKD. We excluded pregnant women with a history of transplantation or maintenance dialysis.
  
  
  RESULTS
  We identified 13 studies. Adverse maternal events including gestational hypertension, pre-eclampsia, eclampsia, and maternal mortality were reported in 12 studies. There were 312 adverse maternal events among 2682 pregnancies in women with CKD (weighted average of 11.5%) compared with 500 events in 26,149 pregnancies in normal healthy women (weighted average of 2%). One or more adverse fetal outcomes such as premature births, intrauterine growth restriction, small for gestational age, neonatal mortality, stillbirths, and low birth weight were reported in nine of the included studies. Overall, the risk of developing an adverse fetal outcome was at least two times higher among women with CKD compared with those without.
  
  
  CONCLUSIONS
  This review summarizes current available evidence to guide physicians in their decision-making, advice, and care for pregnant women with CKD. Additional studies are needed to better characterize the risks.
authors.affiliation: Department of Medicine, University of Western Ontario, London, Ontario, Canada. immaculate.nevis@lhsc.on.ca
authors.forename: Immaculate F
authors.initials: IF
authors.lastname: Nevis
authors.forename: Angela
authors.initials: A
authors.lastname: Reitsma
authors.forename: Arunmozhi
authors.initials: A
authors.lastname: Dominic
authors.forename: Sarah
authors.initials: S
authors.lastname: McDonald
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.forename: Michelle
authors.initials: M
authors.lastname: Hladunewich
authors.forename: Ayub
authors.initials: A
authors.lastname: Akbari
authors.forename: Geena
authors.initials: G
authors.lastname: Joseph
authors.forename: Winnie
authors.initials: W
authors.lastname: Sia
authors.forename: Arthur V
authors.initials: AV
authors.lastname: Iansavichus
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D002908:Chronic Disease; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000401:mortality; D011256:Pregnancy Outcome; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors