Zhi Lin Kang1*, Mary Grace Tan1 and Woei Bing Poon1,2,3,4
1Department of Neonatology and Developmental Medicine, Singapore General Hospital, Singapore 2Duke-National University of Singapore Graduate Medical School, Singapore 3Yong Loo Lin School of Medicine, National University of Singapore, Singapore 4Lee Kong Chian School of Medicine, Nanyang Technological University, SingaporeFulltext PDF
Objectives: This study aims to stratify the outcomes of these infants born to mothers with varying stages of Chronic Kidney Disease (CKD) so as to improve obstetric counseling and prognostication. We also aim to look at other prognostic risk factors that may worsen the neonatal outcomes such as presence of hypertension, amongst others. Setting: A single-centre retrospective cohort study was conducted in a tertiary centre. Participants: All pregnancies of mothers with chronic renal impairment diseases were included over the period of August 2012 to December 2020. Other acute maternal renal diseases or mothers with congenital kidney abnormalities were excluded. First trimester termination of pregnancies or spontaneous miscarriages was also excluded. Outcome Measures: Comparison was made between Severe Renal Impairment (SRI) pregnancies with CKD stage 4 to 5 or requiring RRT vs. those with mild to Moderate Renal Impairment (MRI) with CKD stages 1 to 3 and not requiring RRT. Analyses were done to look at prognostic values of maternal hypertension, need for anti-hypertensive medications, and RRT timing, on neonatal outcomes. Results: Out of 74 pregnancies, 15 (20.2%) were SRI pregnancies. Pregnancy with SRI was associated with higher combined mortality or major morbidity (OR 5.889; 95% CI 1.551-22.357), prematurity (OR 15.500, 95% CI 1.913-125.582), maternal hypertension (OR 5.867, 95% CI 1.727-19.932), use of anti-hypertensive in pregnancy (OR 5.786, 95% CI 1.663-20.133) and presence of fetal distress (OR 7.125, 95% CI 1.072-47.371). Presence of hypertension and need for anti-hypertensive medications during pregnancies were associated with higher mortality, combined mortality or major morbidities, prematurity and need for caesarian section. All pregnancies requiring RRT resulted in preterm deliveries. Conclusion: Neonates of SRI pregnancies have significantly increased risk of poorer outcomes. The presence of hypertension and need for anti-hypertensive medications were independent risk factors for worse outcomes in CKD pregnancies.
Neonatal outcomes; Pregnancy; Chronic kidney disease; End stage renal failure; Renal replacement therapy; Prematurity
Kang ZL, Tan MG, Poon WB. Comparing Neonatal Outcomes in Women with Severe Compared to Mild- Moderate Chronic Kidney Disease. Ann Pediatr Res. 2022; 6(1): 1065..