Pregnancy Outcomes in Women with Chronic Kidney Disease: A Systematic Review

[okarol]

Pregnancy Outcomes in Women with Chronic Kidney Disease: A Systematic Review
Immaculate F. Nevis*†, Angela Reitsma†, Arunmozhi Dominic*‡, Sarah McDonald†§, Lehana Thabane†, Elie A. Akl†‖, Michelle Hladunewich¶, Ayub Akbari**, Geena Joseph‡‡, Winnie Sia††, Arthur V. Iansavichus*, Amit X. Garg*†‡
+ Author Affiliations

Departments of *Medicine and
‡Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada;
Department of †Clinical Epidemiology and Biostatistics, and
§Obstetrics and Gynecology and Diagnostic Imaging, McMaster University, Hamilton, Ontario, Canada;
‖Departments of Medicine and Family Medicine, State University of New York at Buffalo, Buffalo, New York;
¶Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;
**Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada;
‡‡Departments of Medicine and Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada
††Department of Medicine and Obstretrics and Gynecology University of Alberta, Alberta, Canada
Correspondence:
Dr. Immaculate Nevis, London Kidney Clinical Research Unit, Room ELL-112, Westminster, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5, Canada. Phone: 519-685-8500, ext 55981; Fax: 519-685-8072; E-mail: immaculate.nevis@lhsc.on.ca
Abstract

Summary

Background and objectives Pregnant women with chronic kidney disease (CKD) are at risk of adverse maternal and fetal outcomes. We conducted a systematic review of observational studies that described this risk.

Design, setting, participants, & measurements We searched several databases from their date of inception through June 2010 for eligible articles published in any language. We included any study that reported maternal or fetal outcomes in at least five pregnant women in each group with or without CKD. We excluded pregnant women with a history of transplantation or maintenance dialysis.

Results We identified 13 studies. Adverse maternal events including gestational hypertension, pre-eclampsia, eclampsia, and maternal mortality were reported in 12 studies. There were 312 adverse maternal events among 2682 pregnancies in women with CKD (weighted average of 11.5%) compared with 500 events in 26,149 pregnancies in normal healthy women (weighted average of 2%). One or more adverse fetal outcomes such as premature births, intrauterine growth restriction, small for gestational age, neonatal mortality, stillbirths, and low birth weight were reported in nine of the included studies. Overall, the risk of developing an adverse fetal outcome was at least two times higher among women with CKD compared with those without.

Conclusions This review summarizes current available evidence to guide physicians in their decision-making, advice, and care for pregnant women with CKD. Additional studies are needed to better characterize the risks.

Received December 5, 2010.
Accepted July 27, 2011.

http://cjasn.asnjournals.org/content/early/2011/09/22/CJN.10841210.abstract