Kidney disease is an independent risk factor for adverse fetal and maternal outcomes in pregnancy

Abstract

Background: Kidney disease has long been recognized to adversely affect fetal and maternal outcomes during pregnancy. The goal of this study is to better describe the population of women with kidney disease and provide a contemporary assessment of their risk for adverse events caused by kidney disease after adjustment for other contributing factors. Methods: We used Colorado birth and death certificate data for 1989 to 2001. Of 747,368 births during this period, 911 births from women with kidney disease were identified, and 4,606 births from women without kidney disease were randomly selected for comparison. Adverse fetal outcomes included fetal prematurity, low birth weight, or neonatal death, whereas adverse maternal outcomes included preeclampsia, eclampsia, or abruptio placenta. Results: Women with kidney disease were more likely to have comorbid illnesses, including chronic hypertension, anemia, diabetes, and lung and cardiac disease. Women with kidney disease had a greater frequency of adverse fetal (18.2% versus 9.5%) and maternal outcomes (13.7% versus 4.3%) compared with women without kidney disease (P < 0.0001). The presence of kidney disease independently increased the likelihood of adverse fetal outcomes (adjusted odds ratio [OR], 1.76; 95% confidence interval [CI], 1.40 to 2.21) and occurrence of adverse maternal outcomes, especially in the middle 1990s, among nulliparous women (adjusted OR, 4.07; 95% CI, 2.17 to 7.66). Conclusion: This analysis shows that independent of other risk factors, kidney disease significantly increases the likelihood of unfavorable pregnancy outcomes for both mother and child.