Lian Xingji, Fan Li, Ning Xin, Wang Cong, Lin Yi, Chen Wenfang, Chen Wei, Yu Xueqing
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
NHC Key Laboratory of Nephrology (Sun Yat-sen University), Guangzhou, China.
Kidney Dis (Basel). 2021 Dec 9;8(2):160-167. doi: 10.1159/000520586. eCollection 2022 Mar.
Gestation complications have a recurrence risk and could predispose to each other in the next pregnancy. We aimed to evaluate the relationship between a history of adverse pregnancy and maternal-fetal outcomes in subsequent pregnancy in patients with Immunoglobulin A nephropathy (IgAN).
A retrospective cohort study from a Chinese single center was conducted. Pregnant women with biopsy-proven primary IgAN and aged ≥18 years were enrolled and divided into the 2 groups by a history of adverse pregnancy. The primary outcome was adverse pregnancy outcome, which included maternal-fetal outcomes. Logistical regression model was used to evaluate the association of a history of adverse pregnancy with subsequent adverse maternal and fetal outcomes.
Ninety-one women with 100 pregnancies were included, of which 54 (54%) pregnancies had a history of adverse pregnancy. IgAN patients with adverse pregnancy history had more composite maternal outcomes (70.4% vs. 45.7%, = 0.012), while there was no difference in the composite adverse fetal outcomes between the 2 groups (55.6% vs. 45.7%). IgAN patients with a history of adverse pregnancy were associated with an increased risk of subsequent adverse maternal outcomes (adjusted odds ratio [OR], 2.64; 95% CI, 1.07-6.47). Similar results were shown in those with baseline serum albumin <3.5 g/dL, 24 h proteinuria ≥1 g/day, and a history of hypertension. There was no association between a history of adverse pregnancy and subsequent adverse fetal outcomes in IgAN patients (adjusted OR, 1.56; 95% CI, 0.63-3.87).
A history of adverse pregnancy was associated with an increased risk of subsequent adverse maternal outcomes, but not for adverse fetal outcomes in IgAN patients.
妊娠并发症存在复发风险，且在下一次妊娠中可能相互影响。我们旨在评估免疫球蛋白A肾病（IgAN）患者既往不良妊娠史与后续妊娠中母胎结局之间的关系。
进行了一项来自中国单中心的回顾性队列研究。纳入经活检证实为原发性IgAN且年龄≥18岁的孕妇，并根据既往不良妊娠史将其分为两组。主要结局为不良妊娠结局，包括母胎结局。采用逻辑回归模型评估既往不良妊娠史与后续母胎不良结局之间的关联。
共纳入91名女性的100次妊娠，其中54次（54%）妊娠有不良妊娠史。有不良妊娠史的IgAN患者有更多的综合母体结局（70.4%对45.7%，P = 0.012），而两组间综合不良胎儿结局无差异（55.6%对45.7%）。有不良妊娠史的IgAN患者后续发生不良母体结局的风险增加（调整后的优势比[OR]，2.64；95%可信区间[CI]，1.07 - 6.47）。在基线血清白蛋白<3.5 g/dL、24小时蛋白尿≥1 g/天以及有高血压病史的患者中也显示出类似结果。IgAN患者既往不良妊娠史与后续不良胎儿结局之间无关联（调整后的OR，1.56；95% CI，0.63 - 3.87）。
既往不良妊娠史与IgAN患者后续发生不良母体结局的风险增加相关，但与不良胎儿结局无关。
