Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico.
Obstetrics Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Mexico.
Am J Nephrol. 2019;49(5):386-396. doi: 10.1159/000499964. Epub 2019 Apr 12.
Chronic kidney disease (CKD) is a global public health problem and is linked to adverse outcomes during pregnancy; the high prevalence of CKD (3-6%) in women of childbearing age is of particular relevance in emerging countries where CKD prevalence is higher and resources are limited. Although CKD is a public health problem in Mexico, there is scant information on outcomes in pregnant CKD women in this country. We report maternal-fetal outcomes in a prospective cohort of poor, CKD pregnant women, and compare results with those of pregnant women without CKD.
A prospective study of pregnant CKD women referred to a public obstetrics/nephrology clinic from July 2013 to December 2017; sociodemographic and clinical data, including complications and perinatal outcomes, were recorded. CKD was defined at referral as per KDIGO guidelines; preeclampsia and superimposed preeclampsia were defined as appearance or worsening of hypertension and proteinuria. Findings were compared to official data for -Mexico and to a historic control of pregnant women without CKD who delivered at our hospital.
Sixty-two pregnancies in CKD patients, age 23.4 ± 5.8 years were observed; 46.8% of patients were primiparous. At referral, serum creatinine was 1.8 (1.1-3.0) mg/dL with an estimate glomerular filtration rate (eGFR) of 38.1 (21.9-68.0) mL/min/1.73 m2. In half of the cases, CKD was diagnosed during pregnancy. Forty-eight pregnant women without CKD, age 27 (22-34) years, who delivered during the study period were selected as controls: 33% were primiparous, serum creatinine was 0.50 (0.4-0.6) mg/dL, and estimate glomerular filtration rate was 135 (112-174) mL/min/1.73 m2. Twenty patients needed dialysis (HD-CKD): 2 were already on dialysis, and 18 began treatment during pregnancy; 42 CKD patients did not require dialysis (non-HD CKD). After delivery, 15 patients remained dialysis dependent while 5 did not. Preeclampsia was more frequent in CKD patients in comparison to controls. In total, 93% of CKD patients and 98% of controls delivered a live baby. Prematurity was more frequent in CKD patients than controls and was higher in HD-CKD than in non-HD CKD. Birth weight was lower in CKD when compared to controls. Logistic regression showed a higher risk of preeclampsia in CKD pregnancies than in controls, but it was not affected by age, parity, CKD stage, or need for dialysis during pregnancy.
Underserved CKD Mexican women have a high rate of adverse maternal-fetal outcomes during pregnancy. The risk may be higher in patients needing dialysis during pregnancy, many of whom remained dialysis dependent after delivery.
慢性肾脏病（CKD）是一个全球性的公共卫生问题，与妊娠期间的不良结局有关；育龄期妇女 CKD 的高患病率（3-6%）在资源有限的新兴国家尤为重要，因为这些国家的 CKD 患病率更高。尽管 CKD 是墨西哥的一个公共卫生问题，但在该国，关于妊娠 CKD 妇女的结局信息很少。我们报告了在一个前瞻性队列中，贫困的 CKD 孕妇的母婴结局，并将结果与无 CKD 的孕妇进行了比较。
这是一项对 2013 年 7 月至 2017 年 12 月期间被转诊到一家公立妇产科/肾病科诊所的 CKD 孕妇进行的前瞻性研究；记录了社会人口统计学和临床数据，包括并发症和围产期结局。CKD 在转诊时根据 KDIGO 指南定义；子痫前期和重叠子痫前期定义为高血压和蛋白尿的出现或恶化。研究结果与墨西哥的官方数据以及我院无 CKD 孕妇的历史对照进行了比较。
共观察到 62 例 CKD 患者的 62 次妊娠，年龄为 23.4 ± 5.8 岁；46.8%的患者为初产妇。转诊时，血清肌酐为 1.8（1.1-3.0）mg/dL，估算肾小球滤过率（eGFR）为 38.1（21.9-68.0）mL/min/1.73 m2。一半的 CKD 病例是在妊娠期间诊断的。选择了在研究期间分娩的 48 名无 CKD 的年龄为 27（22-34）岁的孕妇作为对照：33%为初产妇，血清肌酐为 0.50（0.4-0.6）mg/dL，估算肾小球滤过率为 135（112-174）mL/min/1.73 m2。20 名患者需要透析（HD-CKD）：2 名患者已经在透析，18 名患者在妊娠期间开始治疗；42 名 CKD 患者不需要透析（非 HD-CKD）。分娩后，15 名患者仍依赖透析，5 名患者不再依赖透析。与对照组相比，CKD 患者的子痫前期更为常见。总的来说，93%的 CKD 患者和 98%的对照组都分娩了活婴。CKD 患者的早产率高于对照组，HD-CKD 患者的早产率高于非 HD-CKD 患者。与对照组相比，CKD 患者的出生体重较低。Logistic 回归显示，CKD 妊娠的子痫前期风险高于对照组，但不受年龄、产次、CKD 分期或妊娠期间透析需求的影响。
墨西哥服务不足的 CKD 妇女在妊娠期间母婴不良结局的发生率较高。在需要在妊娠期间透析的患者中，风险可能更高，其中许多患者分娩后仍依赖透析。
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