Fassio Federica, Attini Rossella, Masturzo Bianca, Montersino Benedetta, Chatrenet Antoine, Saulnier Patrick, Cabiddu Gianfranca, Revelli Alberto, Gennarelli Gianluca, Gazzani Isabella Bianca, Muccinelli Elisabetta, Plazzotta Claudio, Menato Guido, Piccoli Giorgina Barbara
Obstetrics, Department of Surgery, University of Torino, Torino 10100, Italy.
Nephrology, Centre Hospitalier Le Mans, Le Mans 72000, France.
J Clin Med. 2019 Oct 28;8(11):1806. doi: 10.3390/jcm8111806.
Preeclampsia (PE) is a risk factor for kidney diseases; egg-donation (ED) increasingly used for overcoming fertility reduction, is a risk factor for PE. CKD is also a risk factor for PE. However, kidney function is not routinely assessed in ED pregnancies. Objective of the study is seeking to assess the importance of kidney function and maternal comorbidity in ED pregnancies.
retrospective observational study from clinical charts.
Sant'Anna Hospital, Turin, Italy (over 7000 deliveries per year).
cases: 296 singleton pregnancies from ED (gestation > 24 weeks), who delivered January 2008-February 2019. Controls were selected from the TOrino Cagliari Observational Study (1407 low-risk singleton pregnancies 2009-2016).
Standard descriptive analysis. Logistic multiple regression analysis tested: PE; pregnancy-induced hypertension; preterm delivery; small for gestational age; explicatory variables: age; BMI; parity; comorbidity (kidney diseases; immunologic diseases; thyroid diseases; other). Delivery over time was analyzed according to Kaplan Meier; ROC (Relative Operating Characteristic) curves were tested for PE and pre-term delivery, employing serum creatinine and e-GFR as continuous variables. The analysis was performed with SPSS v.14.0 and MedCalc v.18.
In keeping with ED indications, maternal age was high (44 years). Comorbidity was common: at least one potential comorbid factor was found in about 40% of the cases (kidney disease: 3.7%, immunologic 6.4%, thyroid disease 18.9%, other-including hypertension, previous neoplasia and all other relevant diseases-10.8%). No difference in age, parity and BMI is observed in ED women with and without comorbidity. Patients with baseline renal disease or "other" comorbidity had a higher risk of developing PE or preterm delivery after ED. PE was recorded in 23% vs. 9%, OR: 2.513 (CI 1.066-5.923; = 0.039); preterm delivery: 30.2% vs. 14%, OR 2.565 (CI: 1.198-5.488; = 0.044). Limiting the analysis to 124 cases (41.9%) with available serum creatinine measurement, higher serum creatinine (dichotomised at the median: 0.67 mg/dL) was correlated with risk of PE (multivariate OR 17.277 (CI: 5.125-58.238)) and preterm delivery (multivariate OR 2.545 (CI: 1.100-5.892).
Within the limits of a retrospective analysis, this study suggests that the risk of PE after ED is modulated by comorbidity. While the cause effect relationship is difficult to ascertain, the relationship between serum creatinine and outcomes suggests that more attention is needed to baseline kidney function and comorbidity.
子痫前期（PE）是肾脏疾病的一个风险因素；越来越多地用于克服生育力下降的卵子捐赠（ED）是PE的一个风险因素。慢性肾脏病（CKD）也是PE的一个风险因素。然而，在接受卵子捐赠的妊娠中，肾功能并非常规评估项目。本研究的目的是评估肾功能和母体合并症在卵子捐赠妊娠中的重要性。
基于临床病历的回顾性观察研究。
意大利都灵的圣安娜医院（每年分娩超过7000例）。
病例组：296例卵子捐赠单胎妊娠（孕周>24周），于2008年1月至2019年2月分娩。对照组选自都灵-卡利亚里观察性研究（2009 - 2016年1407例低风险单胎妊娠）。
标准描述性分析。采用逻辑多元回归分析检测：子痫前期；妊娠高血压；早产；小于胎龄儿；解释变量：年龄；体重指数；产次；合并症（肾脏疾病；免疫性疾病；甲状腺疾病；其他）。根据Kaplan Meier法分析随时间的分娩情况；以血清肌酐和估算肾小球滤过率（e - GFR）作为连续变量，绘制子痫前期和早产的ROC（相对操作特征）曲线。分析使用SPSS v.14.0和MedCalc v.18软件进行。
符合卵子捐赠指征，产妇年龄较大（44岁）。合并症很常见：约40%的病例中发现至少一种潜在合并因素（肾脏疾病：3.7%，免疫性疾病6.4%，甲状腺疾病18.9%，其他 - 包括高血压、既往肿瘤及所有其他相关疾病 - 10.8%）。有合并症和无合并症的卵子捐赠女性在年龄、产次和体重指数方面未观察到差异。基线患有肾脏疾病或“其他”合并症的患者在卵子捐赠后发生子痫前期或早产的风险更高。子痫前期发生率为23% 对比9%，比值比（OR）：2.513（95%置信区间[CI] 1.066 - 5.923；P = 0.039）；早产发生率：30.2%对比14%，OR 2.565（CI：1.198 - 5.488；P = 0.044）。将分析局限于124例（41.9%）有可用血清肌酐测量值的病例，较高的血清肌酐（以中位数0.67mg/dL进行二分法划分）与子痫前期风险（多变量OR 17.277（CI：5.125 - 58.238））和早产风险（多变量OR 2.545（CI：1.100 - 5.892））相关。
在回顾性分析的局限性内，本研究表明卵子捐赠后子痫前期的风险受合并症影响。虽然因果关系难以确定，但血清肌酐与结局之间的关系表明需要更多关注基线肾功能和合并症。
