Abstract: FR-PO866
Temporal Trends in Pregnant CKD Patients
Session Information
- Women's Health and Kidney Diseases
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Koirala, Priscilla, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Garovic, Vesna D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Kattah, Andrea G., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Chronic kidney disease (CKD) during pregnancy significantly increases both maternal and perinatal morbidity and mortality and the incidence of CKD is increasing in persons of childbearing age. In this study, we aimed to identify changes in demographics and comorbidities over time in people with CKD and pregnancy in our tertiary care practice.
Methods
We identified pregnancies delivered at Mayo Clinic in Rochester, MN from 2010 to 2022 and screened the population for ICD-9/10 codes for CKD present prior to the date of delivery. If more than 1 pregnancy occurred in the study period, we evaluated the first pregnancy with pre-existing CKD. We abstracted data on demographics, comorbidities, body-mass index, etiology and stage of CKD. Maternal and perinatal outcomes were evaluated. We compared characteristics by era –2010 to 2016 vs. 2016 to 2022 – using Fischer’s exact test for categorical variables and Kruskal-Wallis test for continuous variables. Correlations were evaluated by Spearman’s correlations.
Results
We identified 67 deliveries in patients with pre-existing CKD. Median (interquartile range (IQR)) pre-pregnancy BMI was lower prior to 2016 than after (24 (22-31) vs. 30.5 (24-34.5), p=0.048). There was also a significant trend toward increasing BMI by year of delivery (ρ = 0.27, p = 0.04). Consistent with this trend was the increasing incidence of CKD due to diabetes (14.8% to to 27.3%, before vs. after 2016), though this was not statistically significant. Six patients had biopsies during pregnancy, between 11 and 24 weeks gestation, that established the cause of CKD and had no complications. There was no increase in the incidence of preeclampsia, preterm delivery or maternal ICU stays by era. The eGFR at baseline was significantly associated with gestational age at delivery (ρ = 0.32, p= 0.01) and birth weight (ρ = 0.30, p = 0.02).
Conclusion
We found that pre-pregnancy BMI has been increasing over time in patients with CKD. Additionally, worse baseline kidney function was associated with earlier gestational age at delivery and lower birth weight in infants. Given that obesity impacts both pregnancy and CKD health and that there are more obesity treatments available, more investigations should be done to understand whether treatment of obesity prior to conception could impact outcomes of pregnancy in patients with CKD.