Piccoli Giorgina Barbara, Kooij Isabelle Annemijn, Attini Rossella, Montersino Benedetta, Fassio Federica, Gerbino Martina, Biolcati Marilisa, Cabiddu Gianfranca, Versino Elisabetta, Todros Tullia
Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, 10100 Torino, Italy.
Nephrologie, Centre Hospitalier Le Mans, Avenue Roubillard, 72000 Le Mans, France.
J Clin Med. 2018 Aug 11;7(8):212. doi: 10.3390/jcm7080212.
IgA nephropathy is the most common primary glomerulonephritis in pregnancy and shares with other immunologic diseases and kidney diseases a relationship with adverse maternal outcomes, whose entity and pattern is only partially quantified. Recent studies provide new information and a systematic review regarded progression of kidney disease. The discussion of the outcomes with respect to low-risk pregnancies may help to perfect the estimation of the risks, and to identify specific research needs.
A search strategy was built on Medline, EMBASE and the Cochrane review for the period January 2000⁻April 2017, aimed at retrieving both case series (defined as with at least 6 pregnancies in women with IgA nephropathy) and case reports, to look into rare occurrences. All papers, with or without control groups, were selected if they reported on at least one pregnancy outcome, or on long-term kidney function. Search strategy, paper selection and data extraction were done in duplicate (PROSPERO N 42016042623). Meta-analysis of case series was performed with Metanalyst Beta 3.13. Case reports were analysed narratively.
The search retrieved 556 papers, of which 27 were included (13 series and 14 case-reports). The case series report on 581 women with 729 pregnancies. The analysis was performed in comparison to the available control groups: 562 non-pregnant controls were available for the analysis of progression of kidney disease. As for pregnancy related outcomes (preeclampsia (PE), pregnancy induced hypertension (PIH), preterm birth, small babies), we meta-analyzed the data with respect to the only series of low-risk pregnancies (1418 pregnancies). When compared with women who never got pregnant after diagnosis of IgA nephropathy, in the present meta-analysis pregnancy in women with IgA nephropathy was not associated with a higher risk of progression of kidney disease, possibly due to the overall preserved kidney function at baseline: end-stage kidney disease (OR 0.68; CI 0.28⁻1.65). Conversely, the incidence of adverse pregnancy-related outcomes was increased compared to low-risk controls: PE and PIH were more than ten-fold increased (OR 11.80; CI 7.53⁻18.48 and OR 10.39; CI 5.45⁻19.80), while the increase in risk of preterm birth and "low birth weight babies" was less marked (OR 3.37; CI 1.91⁻5.95 and OR 2.36; CI 1.52⁻3.66), a discrepancy suggesting the occurrence of "late" or "maternal" PE, that may affect less severely foetal growth or shorten gestation. In conclusion, in the present meta-analysis IgA nephropathy was not associated with an increased progression of kidney disease. The more than ten-fold increased risk of PIH and PE, in combination with a doubled risk of small babies, suggests the occurrence of "late" or "maternal" PE, usually less affecting early foetal growth. This finding may be of help in defining control policies, while further research is needed to guide clinical management.
IgA肾病是妊娠期间最常见的原发性肾小球肾炎，与其他免疫性疾病和肾脏疾病一样，与不良母体结局相关，但其具体情况和模式仅得到部分量化。近期研究提供了新信息以及关于肾脏疾病进展的系统评价。对低风险妊娠结局的讨论可能有助于完善风险评估，并确定具体的研究需求。
基于Medline、EMBASE和Cochrane综述构建了2000年1月至2017年4月期间的检索策略，旨在检索病例系列（定义为IgA肾病女性至少有6次妊娠）和病例报告，以研究罕见情况。如果所有论文报告了至少一项妊娠结局或长期肾功能，则无论有无对照组均被选中。检索策略、论文选择和数据提取均重复进行（PROSPERO编号N 42016042623）。使用Metanalyst Beta 3.13对病例系列进行荟萃分析。对病例报告进行叙述性分析。
检索到556篇论文，其中27篇被纳入（13个系列和14篇病例报告）。病例系列报告了581名女性的729次妊娠。与可用对照组进行比较分析：有562名非妊娠对照可用于分析肾脏疾病进展。至于妊娠相关结局（子痫前期（PE）、妊娠高血压（PIH）、早产、低体重儿），我们对仅有的低风险妊娠系列（1418次妊娠）的数据进行了荟萃分析。与诊断IgA肾病后从未怀孕的女性相比，在本次荟萃分析中，IgA肾病女性妊娠与肾脏疾病进展风险升高无关，这可能是由于基线时总体肾功能良好：终末期肾病（OR 0.68；CI 0.28 - 1.65）。相反，与低风险对照相比，不良妊娠相关结局的发生率增加：PE和PIH增加了十多倍（OR 11.80；CI 7.53 - 18.48和OR 10.39；CI 5.45 - 19.80），而早产和“低体重儿”风险的增加则不太明显（OR 3.37；CI 1.91 - 5.95和OR 2.36；CI 1.52 - 3.66），这种差异表明存在“晚期”或“母体”PE，可能对胎儿生长影响较小或缩短妊娠期。总之，在本次荟萃分析中，IgA肾病与肾脏疾病进展增加无关。PIH和PE风险增加十多倍，同时低体重儿风险翻倍，表明存在“晚期”或“母体”PE，通常对早期胎儿生长影响较小。这一发现可能有助于确定控制策略，同时需要进一步研究来指导临床管理。
