title: Multiple pregnancies in CKD patients: an explosive mix.
abstract: OBJECTIVE
  CKD and multiple pregnancies bear important risks for pregnancy outcomes. The aim of the study was to define the risk for adverse pregnancy-related outcomes in multiple pregnancies in CKD patients in comparison with a control group of "low-risk" multiple pregnancies.
  
  
  METHODS
  The study was performed in the Maternal Hospital of the University of Turin, Italy. Of 314 pregnancies referred in CKD (2000-2011), 20 were multiple (15 twin deliveries). Control groups consisted of 379 low-risk multiple pregnancies (314 twin deliveries) and 19 (15 twin deliveries) cases with hypertension-collagen diseases. Baseline data and outcomes were compared by univariate and logistic regression analyses.
  
  
  RESULTS
  The prevalence of multiple pregnancies was relatively high in the CKD population (6.4%); all referred cases were in early CKD stages (I-II); both creatinine (0.68 to 0.79 mg/dl; P=0.010) and proteinuria (0.81 to 3.42 g/d; P=0.041) significantly increased from referral to delivery. No significant difference in demographic data at baseline was found between cases and low-risk controls. CKD was associated with higher risk of adverse pregnancy outcomes versus low-risk twin pregnancies. Statistical significance was reached for preterm delivery (<34 weeks: 60% vs 26.4%; P=0.005; <32 weeks: 53.3% vs 12.7%; P<0.001), small for gestational age babies (28.6% vs 8.1%; P<0.001), need for Neonatal Intensive Care Unit (60% vs 12.7%; P<0.001), weight discordance between twins (40% vs 17.8%; P=0.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P=0.032).
  
  
  CONCLUSIONS
  This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages.
authors.affiliation: Clinical and Biological Sciences, University of Torino at San Luigi, Turin, Italy. gbpiccoli@yahoo.it
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Silvana
authors.initials: S
authors.lastname: Arduino
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.forename: Silvia
authors.initials: S
authors.lastname: Parisi
authors.forename: Federica
authors.initials: F
authors.lastname: Fassio
authors.forename: Marlisa
authors.initials: M
authors.lastname: Biolcati
authors.forename: Arianna
authors.initials: A
authors.lastname: Pagano
authors.forename: Carlotta
authors.initials: C
authors.lastname: Bossotti
authors.forename: Elena
authors.initials: E
authors.lastname: Vasario
authors.forename: Valentina
authors.initials: V
authors.lastname: Borgarello
authors.forename: Germana
authors.initials: G
authors.lastname: Daidola
authors.forename: Martina
authors.initials: M
authors.lastname: Ferraresi
authors.forename: Pietro
authors.initials: P
authors.lastname: Gaglioti
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D015999:Multivariate Analysis; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors