Ramin Susan M, Vidaeff Alex C, Yeomans Edward R, Gilstrap Larry C
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
Obstet Gynecol. 2006 Dec;108(6):1531-9. doi: 10.1097/01.AOG.0000246790.84218.44.
The purpose of this review was to examine the impact of varying degrees of renal insufficiency on pregnancy outcome in women with chronic renal disease. Our search of the literature did not reveal any randomized clinical trials or meta-analyses. The available information is derived from opinion, reviews, retrospective series, and limited observational series. It appears that chronic renal disease in pregnancy is uncommon, occurring in 0.03-0.12% of all pregnancies from two U.S. population-based and registry studies. Maternal complications associated with chronic renal disease include preeclampsia, worsening renal function, preterm delivery, anemia, chronic hypertension, and cesarean delivery. The live birth rate in women with chronic renal disease ranges between 64% and 98% depending on the severity of renal insufficiency and presence of hypertension. Significant proteinuria may be an indicator of underlying renal insufficiency. Management of pregnant women with underlying renal disease should ideally entail a multidisciplinary approach at a tertiary center and include a maternal-fetal medicine specialist and a nephrologist. Such women should receive counseling regarding the pregnancy outcomes in association with maternal chronic renal disease and the effect of pregnancy on renal function, especially within the ensuing 5 years postpartum. These women will require frequent visits and monitoring of renal function during pregnancy. Women whose renal disease is further complicated by hypertension should be counseled regarding the increased risk of adverse outcome and need for blood pressure control. Some antihypertensives, especially angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, should be avoided during pregnancy, if possible, because of the potential for both teratogenic (hypocalvaria) and fetal effects (renal failure, oliguria, and demise).
本综述的目的是研究不同程度的肾功能不全对慢性肾病女性妊娠结局的影响。我们对文献的检索未发现任何随机临床试验或荟萃分析。现有信息来自观点、综述、回顾性系列研究以及有限的观察性系列研究。妊娠合并慢性肾病似乎并不常见，在美国两项基于人群的登记研究中，其在所有妊娠中的发生率为0.03% - 0.12%。与慢性肾病相关的母体并发症包括先兆子痫、肾功能恶化、早产、贫血、慢性高血压和剖宫产。慢性肾病女性的活产率在64%至98%之间，具体取决于肾功能不全的严重程度和高血压的存在情况。显著蛋白尿可能是潜在肾功能不全的一个指标。患有基础肾病的孕妇的管理理想情况下应在三级中心采用多学科方法，包括母胎医学专家和肾病学家。这些女性应接受关于妊娠结局与母体慢性肾病以及妊娠对肾功能的影响的咨询，尤其是在产后5年内。这些女性在孕期需要频繁就诊并监测肾功能。肾病合并高血压的女性应被告知不良结局风险增加以及控制血压的必要性。某些抗高血压药物，尤其是血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂，在孕期应尽可能避免使用，因为它们可能有致畸作用（颅骨发育不全）和对胎儿的影响（肾衰竭、少尿和死亡）。
