Multiple Pregnancies in CKD Patients

Abstract

SummaryBackground and objectives CKD and multiple pregnancies bear important risks for pregnancy outcomes. The aim of the study was to define the risk for adverse pregnancy-related outcomes in multiple pregnancies in CKD patients in comparison with a control group of "low-risk" multiple pregnancies.Design, setting, participants, & measurements The study was performed in the Maternal Hospital of the University of Turin, Italy. Of 314 pregnancies referred in CKD (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011), 20 were multiple (15 twin deliveries). Control groups consisted of 379 low-risk multiple pregnancies (314 twin deliveries) and 19 (15 twin deliveries) cases with hypertension-collagen diseases. Baseline data and outcomes were compared by univariate and logistic regression analyses.Results The prevalence of multiple pregnancies was relatively high in the CKD population (6.4%); all referred cases were in early CKD stages (I-II); both creatinine (0.68 to 0.79 mg/dl; P50.010) and proteinuria (0.81 to 3.42 g/d; P50.041) significantly increased from referral to delivery. No significant difference in demographic data at baseline was found between cases and low-risk controls. CKD was associated with higher risk of adverse pregnancy outcomes versus low-risk twin pregnancies. Statistical significance was reached for preterm delivery (,34 weeks: 60% vs 26.4%; P50.005; ,32 weeks: 53.3% vs 12.7%; P,0.001), small for gestational age babies (28.6% vs 8.1%; P,0.001), need for Neonatal Intensive Care Unit (60% vs 12.7%; P,0.001), weight discordance between twins (40% vs 17.8%; P50.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P50.032).Conclusion This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages.

Severe Diabetic Nephropathy in Type 1 Diabetes and Pregnancy - A Case Series

“…Furthermore, in dealing with type 1 diabetes patients it does not consider the two emerging categories of diabetes in pregnancy: gestational diabetes and type 2 diabetes mellitus [32][33][34][35]. However, within these obvious limitations, it is one of few studies describing patients with "severe" diabetic nephropathy referred to nephrological healthcare.…”

A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy

“…single and spontaneous pregnancies. Multiple pregnancies and assisted fertilization procedures bear a higher risk of PE; these two elements are related, since assisted fertilization often leads to multiple pregnancies and their incidence is increasing, due to higher maternal age (per se associated with multiple pregnancies) and to the diffusion of assisted fertilization procedures [110][111][112][113][114][115]. As a rule, the risk for PE increases along with the increase of the number of foetuses; however, this is so closely linked with assisted fertilization that the role of each risk factor is at present almost indistinguishable.…”

Factores clínicos asociados a la hipertensión arterial severa posparto: un estudio de casos y controles en la Clínica San Luis, Bucaramanga, Colombia

“…En contraste con otras investigaciones, la hipertensión gestacional fue una variable de riesgo más significativa que la preeclampsia anteparto para desarrollar hipertensión arterial severa posparto (RM 3,19; IC 95% 1,88-5,41) (21), mientras la raza (raza caucá-sica) fue la única variable protectora (RM 0,11; IC 95% 0,06-0,18), acorde con algunos artículos europeos (20) y en contra de otros estudios anglosajones (22,25).…”

“…Algunos apuntan a la clara asociación entre ciertos factores como obesidad, hipertensión gestacional anteparto, hiperuricemia y proteinuria (25,29); mientras otros no reportan una asociación significativa (2). Lo anterior, sumado a las variaciones regionales existentes en la presentación de los THAE por su multifactorialidad (14,(33)(34)(35), llevó a plantear el objetivo general de este estudio: determinar los factores clínicos presentes antes y durante el embarazo que se asocian a la hipertensión arterial severa en el puerperio.…”

“…Los trastornos hipertensivos durante el anteparto y el posparto son fisiopatológicamente diferentes, por tanto, no pueden ser analizados de la misma forma (6,12,24). No obstante, los mayores esfuerzos en el estudio de los THAE se han enfocado en los eventos anteparto (25)(26)(27)(28)(29).…”