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. 2022 Dec;44(12):1094-1101.
doi: 10.1055/s-0042-1753546. Epub 2022 Dec 29.

Perinatal Outcomes in Women with Chronic Kidney Diseases

Marcus Vinicius Pinheiro Zilli  1 , Anderson Borovac-Pinheiro  1 , Maria Laura Costa  1 , Fernanda Garanhani Surita  1
Affiliations

Perinatal Outcomes in Women with Chronic Kidney Diseases

Marcus Vinicius Pinheiro Zilli et al. Rev Bras Ginecol Obstet. 2022 Dec.

Abstract
in English, Portuguese

Objective: To assess maternal and neonatal outcomes in women with chronic kidney disease (CKD) at a referral center for high-risk pregnancy.

Methods: A retrospective cohort of pregnant women with CKD was followed at the Women's Hospital of Universidade Estadual de Campinas, Brazil, between 2012 and 2020. Variables related to disease etiology, treatment duration, sociodemographic variables, lifestyle, other associated diseases, obstetric history, and perinatal outcomes were assessed. The causes of CKD were grouped into 10 subgroups. Subsequently, we divided the sample according to gestational age at childbirth, as preterm and term births, comparing maternal and neonatal outcomes, and baseline characteristics as well as outcomes among such groups.

Results: A total of 84 pregnancies were included, in 67 women with CKD. Among them, six pregnancies evolved to fetal death, five to miscarriage, and one was a twin pregnancy. We further analyzed 72 single pregnancies with live births; the mean gestational age at birth was 35 weeks and 3 days, with a mean birth weight of 2,444 g. Around half of the sample (51.39%) presented previous hypertension, and 27.7% developed preeclampsia. Among the preterm births, we observed a higher frequency of hypertensive syndromes, longer maternal intensive care unit (ICU) stay in the postpartum period, higher incidence of admission to the neonatal ICU, higher neonatal death, lower 5-minute Apgar score, and lower birth weight.

Conclusion: This study demonstrates increased adverse outcomes among pregnancies complicated by CKD and expands the knowledge on obstetric care among such women in an attempt to reduce maternal risks and identify factors related to prematurity in this population.

Objetivo: Avaliar os desfechos maternos e neonatais em mulheres com doença renal crônica (DRC) em um centro de referência para gestação de alto risco. MéTODOS: Coorte retrospectiva de gestantes com DRC acompanhadas no Hospital da Mulher da Universidade Estadual de Campinas, Brasil, entre 2012 e 2020. Variáveis relacionadas à etiologia da doença, duração do tratamento, variáveis sociodemográficas, estilo de vida, outras doenças associadas, história obstétrica, número de consultas de pré-natal e os resultados perinatais foram avaliados. As causas da DRC foram agrupadas em 10 subgrupos. Posteriormente, dividimos a amostra de acordo com a idade gestacional no parto, pois os nascimentos pré-termo e a termo comparam os desfechos maternos e neonatais bem como as características basais e desfechos entre esses grupos.

Resultados: Um total de 84 gestações foram incluídas em 67 mulheres com DRC. Dentre elas, seis gestações evoluíram para óbito fetal, cinco para aborto espontâneo, e uma era gestação gemelar. Foram analisadas ainda 72 gestações únicas, com nascidos vivos; a idade gestacional média ao nascer foi de 35 semanas e 3 dias, e o peso médio ao nascer foi 2.444 g. Cerca de metade da amostra (51,39%) apresentava hipertensão prévia e 27,7% desenvolveram pré-eclâmpsia. Entre os casos de prematuridade (34 casos), observamos maior frequência de síndromes hipertensivas, mais dias de internação materna na UTI no pós-parto, maior incidência de internação na UTI neonatal, óbito neonatal, menor índice de Apgar de 5 minutos e menor peso ao nascimento. CONCLUSãO: Este estudo demonstra o aumento de desfechos adversos em gestações complicadas por DRC e amplia o conhecimento sobre cuidados obstétricos entre essas mulheres na tentativa de reduzir os riscos maternos e identificar fatores relacionados à prematuridade nessa população.

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Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Main causes of chronic kidney disease among pregnancies followed at high-risk antenatal care ( n  = 84).
See this image and copyright information in PMC

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