Risk of Preeclampsia and Pregnancy Complications in Women With a History of Acute Kidney Injury

Abstract

An episode of clinically recovered acute kidney injury (r-AKI) has been identified as a risk factor for future hypertension and cardiovascular disease. Our objective was to assess whether r-AKI was associated with future preeclampsia and other adverse pregnancy outcomes and to identify whether severity of AKI or time interval between AKI and pregnancy was associated with pregnancy complications. We conducted a retrospective cohort study of women who delivered infants between 1998 and 2016 at Massachusetts General Hospital. AKI was defined using the 2012 Kidney Disease Improving Global Outcomes laboratory criteria with subsequent clinical recovery (estimate glomerular filtration rate, >90 mL/min per 1.73 m² before conception). AKI was further classified by severity (Kidney Disease Improving Global Outcomes stages 1-3) and time interval between AKI episode and the start of pregnancy. Women with r-AKI had an increased rate of preeclampsia compared with women without previous r-AKI (22% versus 9%; P<0.001). Infants of women with r-AKI were born earlier (gestational age, 38.2±3.0 versus 39.0±2.2 weeks; P<0.001) and were more likely to be small for gestational age (9% versus 5%; P=0.002). Increasing severity of r-AKI was associated with increased risk of preeclampsia for stages 2 and 3 AKI (adjusted odds ratio, 3.5; 95% confidence interval, 2.1-5.7 and adjusted odds ratio, 6.5; 95% confidence interval, 3.5-12.0, respectively), but not for stage 1 (adjusted odds ratio, 1.7; 95% confidence interval, 0.9-3.2). A history of AKI before pregnancy, despite apparent full recovery, was associated with increased risk of pregnancy complications. Severity and timing of the AKI episode modified the risk.

Keywords: acute kidney injury; epidemiology; hypertension; preeclampsia; pregnancy.

Figure 1. Cohort Design

Flow of patients into cohort.

Figure 2. Association between KDIGO AKI Stage and Main Maternal-Fetal Outcomes

Association of adverse outcomes with r-AKI from logistic regression by severity of AKI episode (KDIGO Stage 1-3). Please refer to online supplement for point estimates and 95% CIs.

Figure 3. Association between Time Interval and Main Maternal-Fetal Outcomes

Left panel: Frequency (%) of adverse outcomes between r-AKI (stratified by time interval of less than 18 months or great then 18 months from AKI event to pregnancy). Error bars represents 95% CI. Right panel: Association of adverse outcomes with r-AKI stratified by time interval from logistic regression. Please refer to online supplement for point estimates and 95% CIs.