MATERNAL-FETAL OUTCOMES IN PREGNANT WOMEN WITH CHRONIC KIDNEY DISEASE: A RETROSPECTIVE MEXICAN COHORT STUDY

Introduction:

Chronic kidney disease (CKD) during pregnancy is associated with significant maternal and fetal risks. Previous studies have consistently demonstrated an elevated risk of adverse outcomes, including preeclampsia, preterm birth, low birth weight, and neonatal mortality. Renal function may deteriorate further during pregnancy, particularly in women with elevated pre-pregnancy creatinine levels. Despite these challenges, the implementation of multidisciplinary care has increased the likelihood of successful pregnancies in women with CKD. This study aimed to investigate the incidence of maternal and fetal outcomes in a cohort of pregnant women with CKD treated at a hospital in Guadalajara, Mexico.

Methods:

This retrospective cohort study was conducted at a tertiary care hospital in Guadalajara, Mexico. The study period included patients admitted with CKD from 2017 to 2021, during which a total of 30 patients were identified and included in the analysis. Data were extracted from the hospital’s electronic medical records (Nota Medica and ECE), with patient follow-up data throughout pregnancy and peripartum period. The primary outcomes assessed were the need for dialysis during pregnancy, renal recovery postpartum, and the progression or development of CKD post-pregnancy. Secondary outcomes included maternal and fetal mortality, as well as preterm birth and neonatal birth weight.

Results:

The mean age of the patients was 28.87 ± 4.1 years. The patients had a median history of two previous pregnancies, and the nephrological evaluation was conducted during the second trimester at a mean gestational age of 21.02 ± 8.1 weeks. A history of hypertension was noted in 76.6% of the women, while 13.3% had a prior diagnosis of preeclampsia. The mean eGFR was 18.1 ± 10 ml/min/1.73 m², indicative of severe renal impairment. At the time of follow-up, 70% of patients were managed with conservative therapy, of which 17 (56.7%) begin renal replacement therapy (RRT) during the second trimester of pregnancy. Additional clinical data are detailed in Table 1.

As shown on table 2, maternal adverse events occurred in 33.3% of cases, with preeclampsia with severe features representing 16.7%, and preeclampsia in 6.7%. HELLP syndrome, gestational diabetes, and placental abruption were each observed in 3.3% of cases. Fetal adverse events were reported in 84% of pregnancies, with low birth weight documented in 90% of cases and a mean birth weight of 1734.2 g. Preterm births occurred in 40% of pregnancies, with a mean gestational age of 31.3 weeks and a total of 83.4% live births. Also, follow-up status is shown in table 3.

Conclusions:

Pregnancies in women with CKD carry higher risks of adverse maternal-fetal outcomes, underlining the need for multidisciplinary care. Proper prenatal management, is crucial for improving outcomes. Specialized interventions can reduce complications, but further research is required to optimize kidney care protocols for this high-risk population.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.