PPAIRENTS: PREDICT AND PAIRS EDUCATIONAL AND NEURODEVELOPMENTAL TARGETS IN OFFSPRING SURVEY

Introduction:

Data are lacking on long-term effect of maternal CKD on childhood development. We investigated whether offspring of females with CKD during pregnancy achieve cognitive, language, and motor development comparable to population norms when tested with a validated health related quality of life (HRQOL) survey.

Methods:

Single centre, ethically approved observational study in UK. Patients with CKD and a live birth were identified from clinical records and sent an information sheet and unique study ID with link to a secure online survey. After e-consent participants completed baseline demographics and Paediatric Quality of Life Inventory (PedsQL4.0) according to child age through parent proxy reporting. PedsQL4.0 mean scores were compared to age-matched healthy population means using T-tests.

Results:

The response rate was 38.6% (54/140) including 23/54 (42.6%) of non-white ethnicity and 25/54 (46.3%) living in high deprivation postcodes. The majority had CKD stage 2-3 diagnosed prior to or during pregnancy (79.4%) and 4 had CKD stage 4/5. Renal replacement during pregnancy included 7 kidney transplants and 2 females on haemodialysis. Analysis included 79 children from 54 mothers. Median age was 7.6 years (Range 13.7 / IQR 4.9). All but one attended mainstream school. Preterm birth occurred in 18/79 (21.5%) with 9 (11.4%) children born before 34 and none before 28 weeks’ gestation. Low birthweight (<2500g) occurred in 19/79 (24.1%) infants of which 4 were very low birthweight (<1500g).

Medical or neurodevelopmental diagnoses had been made in 18/79 (23%) children. Medical diagnoses included asthma, amblyopia, strabismus, polycystic kidney disease and congenital cardiac anomaly. Diagnoses of autistic spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and combined ASD/ADHD had been made in 5 (6%), 4 (5%) and 2 (3%) respectively.  Delayed speech and language in the absence of ASD occurred in 4 (5%). The prevalence of ASD (6%), ADHD (5%) and use of SEN support (13.9%) were comparable to UK population data.

There were no measurable differences in cognitive, language and motor developmental outcomes measured by PedsQL total score between children of mothers with CKD compared to age matched controls (Table 1). Total PedsQL mean score was within 1 SD for all age groups and was higher than controls aged 5-7 which was the only group without any ASD diagnoses in our cohort. Children aged 5-7 also had a higher physical health summary score compared to controls (91.28 (SD 8.59) vs 80.11(SD 20.85), p=0.009). Adolescents (13–18-year-olds), had measurably lower psychosocial summary score compared to controls (65.7 (SD 18.9) vs 80.55 (SD 15.8), p 0.04) though this was nonsignificant when adjusted for a single participant with severe ASD.

Conclusions:

Our study suggests that children born to mothers with CKD in pregnancy achieve normal childhood cognitive, language and motor development. Pre-term delivery and co-existent childhood disorders including ASD are important confounding factors. Further prospective research with a larger sample size and formal paediatric assessment are needed to confirm these findings.

I have no potential conflict of interest to disclose.

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