Abstract
BackgroundImmunoglobulin A nephropathy (IgAN) incidence peaks in childbearing age. Data on pregnancy outcomes in women with IgAN are limited.MethodsWe performed a register-based cohort study in a nationwide cohort of women with biopsy-verified IgAN in Sweden, comparing 327 pregnancies in 208 women with biopsy-verified IgAN and 1060 pregnancies in a matched reference population of 622 women without IgAN, with secondary comparisons with sisters to IgAN women. Adverse pregnancy outcomes, identified by way of the Swedish Medical Birth Register, were compared through multivariable logistic regression and presented as adjusted odds ratios (aORs). Main outcome was preterm birth (< 37 weeks). Secondary outcomes were preeclampsia, small for gestational age (SGA), low 5-min Apgar score (< 7), fetal or infant loss, cesarean section, and gestational diabetes.ResultsWe found that IgAN was associated with an increased risk of preterm birth (13.1% vs 5.6%; aOR = 2.69; 95% confidence interval [CI] = 1.52–4.77), preeclampsia (13.8% vs 4.2%; aOR = 4.29; 95%CI = 2.42–7.62), SGA birth (16.0% vs 11.1%; aOR = 1.84; 95%CI = 1.17–2.88), and cesarean section (23.9% vs 16.2%; aOR = 1.74, 95%CI = 1.14–2.65). Absolute risks were low for intrauterine (0.6%) or neonatal (0%) death and for low 5-min Apgar score (1.5%), and did not differ from the reference population. Sibling comparisons suggested increased risks of preterm birth, preeclampsia, and SGA in IgAN, but not of cesarean section.ConclusionWe conclude that although most women with IgAN will have a favorable pregnancy outcome, they are at higher risk of preterm birth, preeclampsia and SGA. Intensified supervision during pregnancy is warranted.
Highlights
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis [1, 2] and a leading cause of the global burden of chronic kidney disease (CKD) [2, 3]
Data on pre-pregnancy diabetes mellitus and systemic inflammatory diseases were obtained from the Medical Birth Register (MBR) and the National Patient Register (NPR)
Small for gestational age, cesarean section, stillbirth or neonatal death (≤ 28 days postnatal age), low 5-min Apgar score (< 7) and gestational diabetes mellitus as secondary outcomes
Summary
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis [1, 2] and a leading cause of the global burden of chronic kidney disease (CKD) [2, 3]. Given that there is widespread agreement that CKD increases both maternal and fetal pregnancy risks [4, 5], pregnancy could be a major concern in women with IgAN. One systematic review showed no increased risk for adverse renal outcomes in predominantly early IgAN [6]. Population-based cohort of more than 4,000 patients with biopsy-proven IgAN [16, 17], we examined pregnancy outcomes in a subset of women giving birth between 1992 and 2011 compared with pregnant women from a matched reference population. We hypothesized that women with IgAN are at increased risk of adverse pregnancy outcomes compared to pregnant, matched reference individuals and to their pregnant sisters
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