title: Association of low-protein supplemented diets with fetal growth in pregnant women with CKD.
abstract: OBJECTIVE
  Women affected by CKD increasingly choose to get pregnant. Experience with low-protein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets.
  
  
  METHODS
  This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (>1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies--21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 protein-unrestricted meals allowed per week.
  
  
  RESULTS
  Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P<0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups.
  
  
  CONCLUSIONS
  Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, San Luigi Hospital, and, †Gynecology and Obstetrics 2U, Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Giorgina B
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Filomena
authors.initials: F
authors.lastname: Leone
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: Maria Chiara
authors.initials: MC
authors.lastname: Deagostini
authors.forename: Martina
authors.initials: M
authors.lastname: Ferraresi
authors.forename: Roberta
authors.initials: R
authors.lastname: Clari
authors.forename: Sara
authors.initials: S
authors.lastname: Ghiotto
authors.forename: Marilisa
authors.initials: M
authors.lastname: Biolcati
authors.forename: Domenica
authors.initials: D
authors.lastname: Giuffrida
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rolfo
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000328:Adult; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D018753:Diet, Protein-Restricted / Q000009:adverse effects; D014676:Diet, Vegetarian / Q000009:adverse effects; D019587:Dietary Supplements; D005260:Female; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000209:etiology; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007651:Keto Acids / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011507:Proteinuria / Q000209:etiology
chemical_list: D007651:Keto Acids; D003404:Creatinine