Major adverse pregnancy outcomes are associated with an increased long-term risk of kidney disease, according to a recent study published in the American Journal of Obstetrics & Gynecology .
Key Takeaways
Increased Risk of CKD: Women who experience adverse pregnancy outcomes such as preterm birth, small for gestational age, preeclampsia, gestational diabetes, and other hypertensive disorders have a significantly increased risk of developing chronic kidney disease (CKD) later in life.
Independent Risk Factors: The study suggests that all major adverse pregnancy outcomes should be considered long-term independent risk factors for CKD, emphasizing the importance of ongoing monitoring and management for these women.
Study Cohort: The national cohort study included women with singleton deliveries recorded in the Swedish Medical Birth Register from 1973 to 2015, with follow-up extending through 2018, revealing a strong link between adverse pregnancy outcomes and CKD.
Varying Hazard Ratios: Different adverse pregnancy outcomes had varying hazard ratios for CKD, with other hypertensive disorders and gestational diabetes showing the highest risks, followed by preeclampsia, preterm delivery, and small for gestational age.
Study Details
Population and Methodology
The study analyzed data from the Swedish Medical Birth Register, including women with singleton deliveries from 1973 to 2015. Women with a prior diagnosis of CKD were excluded. The adverse pregnancy outcomes studied were preterm birth, small for gestational age, preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes. The follow-up period extended to December 31, 2018, with a maximum and median follow-up time of 46 and 25 years, respectively. CKD diagnoses were identified using International Classification of Diseases (ICD) codes.
Findings
Prevalence: At least one adverse pregnancy outcome was reported in 30.4% of women, and 8.3% experienced two or more. The most common outcome was small for gestational age (14.3%), followed by preterm delivery (8.8%).
Demographics: Women with small for gestational age or preterm delivery were often younger at first delivery, had lower education or income, or smoked more frequently. Those with preeclampsia generally had lower education or income, higher BMI, and were more likely to smoke. Women with other hypertensive disorders or gestational diabetes were typically older at first delivery, had higher BMI, and were nonsmokers.
CKD and ESKD Incidence: CKD was reported in 0.5% of women during the follow-up period, and end-stage kidney disease (ESKD) in 0.2%. The median age at CKD diagnosis was 61 years, and at ESKD diagnosis was 53 years, with a median follow-up time of 27 years.
Hazard Ratios
Other Hypertensive Disorders: HR of 4 for CKD.
Gestational Diabetes: HR of 3.85.
Preeclampsia: HR of 2.35.
Preterm Delivery: HR of 2.
Small for Gestational Age: HR of 1.25.
Infant birth weight under the fifth percentile for gestational age was also associated with increased CKD risk compared to the tenth percentile or greater, with adjusted HRs of 1.30 and 1.25, respectively.
Temporal Trends
Early Risk: Preterm delivery, preeclampsia, and other hypertensive disorders showed the highest HRs for CKD within the first 10 years post-delivery.
Long-Term Risk: HRs for gestational diabetes were greatest at 20 to 29 years post-delivery, and for small for gestational age at 10 to 19 years. HRs remained significant 30 to 46 years after delivery.
Conclusion
These findings underscore the importance of recognizing major adverse pregnancy outcomes as significant long-term risk factors for CKD. Continuous monitoring and tailored healthcare interventions for women with a history of such outcomes could potentially mitigate the increased risk of CKD. The study advocates for further research and public health strategies to address these risks and improve long-term renal health for affected women.
