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. 2023 Apr 28:11:1110117.
doi: 10.3389/fped.2023.1110117. eCollection 2023.

Maternal risk factors for posterior urethral valves

Loes F M van der Zanden  1 , Sander Groen In 't Woud  1 , Iris A L M van Rooij  1 , Josine S L T Quaedackers  2 , Martijn Steffens  3 , Liesbeth L L de Wall  4 , Michiel F Schreuder  5 , Wout F J Feitz  4 , Nel Roeleveld  1
Affiliations

Maternal risk factors for posterior urethral valves

Loes F M van der Zanden et al. Front Pediatr. .

Abstract

Introduction: Posterior urethral valves (PUV) is a congenital disorder causing an obstruction of the lower urinary tract that affects approximately 1 in 4,000 male live births. PUV is considered a multifactorial disorder, meaning that both genetic and environmental factors are involved in its development. We investigated maternal risk factors for PUV.

Methods: We included 407 PUV patients and 814 controls matched on year of birth from the AGORA data- and biobank and three participating hospitals. Information on potential risk factors (family history of congenital anomalies of the kidney and urinary tract (CAKUT), season of conception, gravidity, subfertility, and conception using assisted reproductive techniques (ART), plus maternal age, body mass index, diabetes, hypertension, smoking, and use of alcohol and folic acid) was derived from maternal questionnaires. After multiple imputation, adjusted odds ratios (aORs) were estimated using conditional logistic regression corrected for minimally sufficient sets of confounders determined using directed acyclic graphs.

Results: A positive family history and low maternal age (<25 years) were associated with PUV development [aORs: 3.3 and 1.7 with 95% confidence intervals (95% CI) 1.4-7.7 and 1.0-2.8, respectively], whereas higher maternal age (>35 years) was associated with a lower risk (aOR: 0.7 95% CI: 0.4-1.0). Maternal preexisting hypertension seemed to increase PUV risk (aOR: 2.1 95% CI: 0.9-5.1), while gestational hypertension seemed to decrease this risk (aOR: 0.6 95% CI: 0.3-1.0). Concerning use of ART, the aORs for the different techniques were all above one, but with very wide 95% CIs including one. None of the other factors studied were associated with PUV development.

Conclusion: Our study showed that family history of CAKUT, low maternal age, and potentially preexisting hypertension were associated with PUV development, whereas higher maternal age and gestational hypertension seemed to be associated with a lower risk. Maternal age and hypertension as well as the possible role of ART in the development of PUV require further research.

Keywords: environment; exposure; maternal; posterior urethral valves (PUV); risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Directed acyclic graph containing all potential risk factors and confounders with their causal relations. Blue circles with black lining: outcome. Blue circles: ancestors of outcome. Pink circles: ancestors of exposure and outcome. Yellow circle: exposure. Grey circle: unobserved variable. BMI, body mass index; CAKUT, congenital anomalies of the kidney and urinary tract; PUV, posterior urethral valves.
Figure 2
Figure 2
Flowchart showing the selection and in- and exclusion of patients and controls in the current study. PUV, posterior urethral valves.
See this image and copyright information in PMC

References

    1. Hamilton AJ, Braddon F, Casula A, Inward C, Lewis M, Mallett T, et al. UK renal registry 18th annual report: chapter 4 demography of patients receiving renal replacement therapy in paediatric centres in the UK in 2014. Nephron. (2016) 132(Suppl 1):99–110. 10.1159/000444818 - DOI - PubMed
    1. Brownlee E, Wragg R, Robb A, Chandran H, Knight M, McCarthy L, et al. Current epidemiology and antenatal presentation of posterior urethral valves: outcome of BAPS CASS national audit. J Pediatr Surg. (2019) 54(2):318–21. 10.1016/j.jpedsurg.2018.10.091 - DOI - PubMed
    1. Krishnan A, de Souza A, Konijeti R, Baskin LS. The anatomy and embryology of posterior urethral valves. J Urol. (2006) 175(4):1214–20. 10.1016/S0022-5347(05)00642-7 - DOI - PubMed
    1. Elumalai G, Mdletshe MB. “Posterior urethral valves” embryological basis and its clinical significance. Elixir Embryol. (2017) 103:45661–4. https://www.researchgate.net/publication/313863457_POSTERIOR_URETHRAL_VA...
    1. Frese S, Weigert A, Hoppe B, Feldkotter M, Ludwig M, Weber S, et al. A classic twin study of lower urinary tract obstruction: report of 3 cases and literature review. Low Urin Tract Symptoms. (2019) 11(2):O85–O8. 10.1111/lluts.12222 - DOI - PubMed

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