title: Kidney disease and maternal and fetal outcomes in pregnancy.
abstract: BACKGROUND
  Pregnancy in kidney disease is considered high risk, but the degree of this risk is unclear. We tested the hypothesis that kidney disease in pregnancy is associated with adverse maternal and fetal outcomes.
  
  
  METHODS
  Retrospective study comparing pregnant women with and without kidney disease.
  
  
  METHODS
  Using data from an integrated health care delivery system from 2000 through 2013, a total of 778 women met the criteria for kidney disease. Using a pool of 74,105 women without kidney disease, we selected 778 women to use for matches for the women with kidney disease. These women were matched 1:1 by age, race, and history of diabetes, chronic hypertension, liver disease, and connective tissue disease.
  
  
  METHODS
  Kidney disease was defined using the NKF-KDOQI definition for chronic kidney disease or International Classification of Diseases, Ninth Revision codes prior to pregnancy or serum creatinine level > 1.2mg/dL and/or proteinuria in the first trimester.
  
  
  METHODS
  Maternal outcomes included preterm delivery, delivery by cesarean section, preeclampsia/eclampsia, length of stay at hospital (>3 days), and maternal death. Fetal outcomes included low birth weight (weight < 2,500g), small for gestational age, number of admissions to neonatal intensive care unit, and infant death.
  
  
  RESULTS
  Compared with women without kidney disease, those with kidney disease had 52% increased odds of preterm delivery (OR, 1.52; 95% CI, 1.16-1.99) and 33% increased odds of delivery by cesarean section (OR, 1.33; 95% CI, 1.06-1.66). Infants born to women with kidney disease had 71% increased odds of admission to the neonatal intensive care unit or infant death compared with infants born to women without kidney disease (OR, 1.71; 95% CI, 1.17-2.51). Kidney disease also was associated with 2-fold increased odds of low birth weight (OR, 2.38; 95% CI, 1.64-3.44). Kidney disease was not associated with increased risk of maternal death.
  
  
  CONCLUSIONS
  Data for level of kidney function and cause of death not available.
  
  
  CONCLUSIONS
  Kidney disease in pregnancy is associated independently with adverse maternal and fetal outcomes when other comorbid conditions are controlled by matching.
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora; Denver Health Medical Center, Denver, CO. Electronic address: jessica.kendrick@ucdenver.edu.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kendrick
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Intermountain Health Care, Salt Lake City, UT.
authors.forename: John
authors.initials: J
authors.lastname: Holmen
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora.
authors.forename: Shyamal
authors.initials: S
authors.lastname: Palit
authors.affiliation: Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Eugene
authors.initials: E
authors.lastname: Nuccio
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora.
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
mesh_terms: D000328:Adult; D002423:Cause of Death; D002585:Cesarean Section / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000453:epidemiology* / Q000503:physiopathology; D007902:Length of Stay / Q000706:statistics & numerical data; D008428:Maternal Mortality; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000503:physiopathology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Pregnancy; cesarean delivery; chronic kidney disease (CKD); death; decreased renal function; fetal outcomes; kidney disease; low birth weight; maternal outcomes; neonatal intensive care unit (NICU) admission; preterm delivery