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Clinical Research
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Risk of Adverse Pregnancy Outcomes in Women with CKD

Giorgina Barbara Piccoli, Gianfranca Cabiddu, Rossella Attini, Federica Neve Vigotti, Stefania Maxia, Nicola Lepori, Milena Tuveri, Marco Massidda, Cecilia Marchi, Silvia Mura, Alessandra Coscia, Marilisa Biolcati, Pietro Gaglioti, Michele Nichelatti, Luciana Pibiri, Giuseppe Chessa, Antonello Pani and Tullia Todros
JASN August 2015, 26 (8) 2011-2022; DOI: https://doi.org/10.1681/ASN.2014050459
Giorgina Barbara Piccoli
*Division of Nephrology, Department of Clinical and Biological Sciences, and
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Gianfranca Cabiddu
†Departments of Nephrology,
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Rossella Attini
Divisions of ‡Obstetrics and
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Federica Neve Vigotti
*Division of Nephrology, Department of Clinical and Biological Sciences, and
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Stefania Maxia
†Departments of Nephrology,
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Nicola Lepori
†Departments of Nephrology,
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Milena Tuveri
§Obstetrics and Gynecology, and
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Marco Massidda
§Obstetrics and Gynecology, and
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Cecilia Marchi
§Obstetrics and Gynecology, and
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Silvia Mura
§Obstetrics and Gynecology, and
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Alessandra Coscia
‖Neonatology, Department of Surgical Sciences, University of Torino, Torino, Italy;
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Marilisa Biolcati
Divisions of ‡Obstetrics and
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Pietro Gaglioti
Divisions of ‡Obstetrics and
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Michele Nichelatti
¶Biostatistics Service, Department of Hematology, Niguarda Ca' Granda Hospital, Milan, Italy
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Luciana Pibiri
**Neonatology, Brotzu Hospital, Cagliari, Italy; and
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Giuseppe Chessa
§Obstetrics and Gynecology, and
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Antonello Pani
†Departments of Nephrology,
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Tullia Todros
Divisions of ‡Obstetrics and
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Abstract

CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (>1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; “general” combined outcome (preterm delivery, NICU, SGA); and “severe” combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4–5: “general” combined outcome, 34.1% versus 90.0%; “severe” combined outcome, 21.4% versus 80.0%; P<0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a “baseline risk” for adverse pregnancy-related outcomes linked to CKD.

  • CKD
  • clinical nephrology
  • hypertension
  • proteinuria
  • risk factors
  • obstetric nephrology
  • Copyright © 2015 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 26 (8)
Journal of the American Society of Nephrology
Vol. 26, Issue 8
August 2015
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Risk of Adverse Pregnancy Outcomes in Women with CKD
Giorgina Barbara Piccoli, Gianfranca Cabiddu, Rossella Attini, Federica Neve Vigotti, Stefania Maxia, Nicola Lepori, Milena Tuveri, Marco Massidda, Cecilia Marchi, Silvia Mura, Alessandra Coscia, Marilisa Biolcati, Pietro Gaglioti, Michele Nichelatti, Luciana Pibiri, Giuseppe Chessa, Antonello Pani, Tullia Todros
JASN Aug 2015, 26 (8) 2011-2022; DOI: 10.1681/ASN.2014050459

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Risk of Adverse Pregnancy Outcomes in Women with CKD
Giorgina Barbara Piccoli, Gianfranca Cabiddu, Rossella Attini, Federica Neve Vigotti, Stefania Maxia, Nicola Lepori, Milena Tuveri, Marco Massidda, Cecilia Marchi, Silvia Mura, Alessandra Coscia, Marilisa Biolcati, Pietro Gaglioti, Michele Nichelatti, Luciana Pibiri, Giuseppe Chessa, Antonello Pani, Tullia Todros
JASN Aug 2015, 26 (8) 2011-2022; DOI: 10.1681/ASN.2014050459
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Keywords

  • CKD
  • clinical nephrology
  • hypertension
  • proteinuria
  • risk factors
  • obstetric nephrology

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