title: Risk of Adverse Pregnancy Outcomes in Women with CKD.
abstract: CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (>1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P<0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.
authors.affiliation: Division of Nephrology, Department of Clinical and Biological Sciences, and giorgina.piccoli@unito.it.
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.affiliation: Departments of Nephrology.
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Cabiddu
authors.affiliation: Divisions of Obstetrics and.
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.affiliation: Division of Nephrology, Department of Clinical and Biological Sciences, and.
authors.forename: Federica Neve
authors.initials: FN
authors.lastname: Vigotti
authors.affiliation: Departments of Nephrology.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maxia
authors.affiliation: Departments of Nephrology.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lepori
authors.affiliation: Obstetrics and Gynecology, and.
authors.forename: Milena
authors.initials: M
authors.lastname: Tuveri
authors.affiliation: Obstetrics and Gynecology, and.
authors.forename: Marco
authors.initials: M
authors.lastname: Massidda
authors.affiliation: Obstetrics and Gynecology, and.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Marchi
authors.affiliation: Obstetrics and Gynecology, and.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mura
authors.affiliation: Neonatology, Department of Surgical Sciences, University of Torino, Torino, Italy;
authors.forename: Alessandra
authors.initials: A
authors.lastname: Coscia
authors.affiliation: Divisions of Obstetrics and.
authors.forename: Marilisa
authors.initials: M
authors.lastname: Biolcati
authors.affiliation: Divisions of Obstetrics and.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gaglioti
authors.affiliation: Biostatistics Service, Department of Hematology, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Nichelatti
authors.affiliation: Neonatology, Brotzu Hospital, Cagliari, Italy; and.
authors.forename: Luciana
authors.initials: L
authors.lastname: Pibiri
authors.affiliation: Obstetrics and Gynecology, and.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Chessa
authors.affiliation: Departments of Nephrology.
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.affiliation: Divisions of Obstetrics and.
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D055815:Young Adult
keywords: CKD; clinical nephrology; hypertension; obstetric nephrology; proteinuria; risk factors