Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street CWN-3, Boston, MA, 02115, USA.
Arch Gynecol Obstet. 2024 Oct;310(4):1975-1980. doi: 10.1007/s00404-024-07685-x. Epub 2024 Aug 16.
Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality, affecting 2-8% of all pregnancies. Typically, the increased glomerular filtration rate of pregnancy results in a decrease in serum creatinine. It is unknown if women without the expected decrease in serum creatinine during pregnancy are more likely to be diagnosed with preeclampsia.
We sought to determine if the absence of a pregnancy-related decrease in serum creatinine was associated with the development of preeclampsia in patients deemed to be at high risk for developing preeclampsia. We hypothesized that the absence of the expected decrease in serum creatinine may be a marker of impaired renal function and therefore may be associated with increased risk of preeclampsia in this cohort.
We conducted a retrospective cohort study of deliveries between November 2, 2017 and June 30, 2020 at a single institution. Pregnancies were included if a baseline serum creatinine (measured between one year prior to conception through 6 weeks gestation), and another serum creatinine value prior to 20 weeks of gestation were measured. Decrease in serum creatinine was defined as any decrease (at least 0.01 mg/dL) from baseline. The primary outcome was diagnosis of preeclampsia. Exclusion criteria included fetal anomalies, fetal demise, multiple gestation, or delivery prior to 20 weeks. Bivariable analyses were performed using Chi-square, ANOVA, and Student's t test. Logistic regression was used to determine odds of developing preeclampsia controlling for confounders.
We identified 392 pregnancies that met inclusion criteria. Preeclampsia was diagnosed in 56 (14.3%) pregnancies. Patients diagnosed with preeclampsia were more likely to have a history of preeclampsia in a prior pregnancy, chronic hypertension (HTN), and diabetes. They were also more likely to have aspirin prescribed in the current pregnancy. Prevalence of advanced maternal age, multiparity, obesity, smoking, history of autoimmune disease, history of CKD, gestational HTN, or multiple pregnancy were not significantly different between patients with and without a diagnosis of preeclampsia. After controlling for confounders, a decrease in serum creatinine from baseline was not significantly associated with a diagnosis of preeclampsia (OR 0.76, CI 0.32-1.78).
After controlling for risk factors associated with preeclampsia, a decrease in serum creatinine from baseline was not significantly associated with a diagnosis of preeclampsia in this high-risk cohort.
子痫前期是孕产妇和新生儿发病率和死亡率的主要原因，影响所有妊娠的 2-8%。通常情况下，妊娠时肾小球滤过率增加会导致血清肌酐降低。目前尚不清楚在妊娠期间未出现预期的血清肌酐降低的女性是否更有可能被诊断为子痫前期。
我们旨在确定在被认为有发生子痫前期风险的患者中，妊娠相关的血清肌酐降低的缺失是否与子痫前期的发生有关。我们假设血清肌酐的预期降低缺失可能是肾功能受损的标志物，因此可能与该队列中子痫前期的风险增加有关。
我们进行了一项单中心回顾性队列研究，纳入 2017 年 11 月 2 日至 2020 年 6 月 30 日期间的分娩。如果在受孕前一年至 6 周妊娠期间测量了基线血清肌酐（测量），并且在妊娠 20 周之前测量了另一个血清肌酐值，则将妊娠纳入研究。血清肌酐降低定义为与基线相比任何降低（至少 0.01mg/dL）。主要结局是子痫前期的诊断。排除标准包括胎儿异常、胎儿死亡、多胎妊娠或妊娠 20 周前分娩。使用卡方检验、方差分析和学生 t 检验进行两变量分析。使用逻辑回归来确定控制混杂因素后发生子痫前期的几率。
我们确定了 392 项符合纳入标准的妊娠。56 例（14.3%）妊娠被诊断为子痫前期。被诊断为子痫前期的患者更有可能在既往妊娠中有子痫前期病史、慢性高血压（HTN）和糖尿病。她们在当前妊娠中更有可能被开阿司匹林。在患有或不患有子痫前期的患者之间，产妇年龄较大、多产、肥胖、吸烟、自身免疫性疾病史、CKD 史、妊娠期 HTN 或多胎妊娠的发生率没有显著差异。在控制混杂因素后，与基线相比血清肌酐的降低与子痫前期的诊断无显著相关性（比值比 0.76，95%置信区间 0.32-1.78）。
在控制与子痫前期相关的危险因素后，与基线相比血清肌酐的降低与该高危队列中子痫前期的诊断无显著相关性。
