Multiple pregnancies in CKD patients: an explosive mix

Giorgina Barbara Piccoli, Piccoli GB, Arduino S, Silvana Arduino, Rossella Attini, Attini R, Parisi S, Silvia Parisi, Fassio F, Federica Fassio, Marlisa Biolcati, Biolcati M, Pagano A, Arianna Pagano, Carlotta Bossotti, Bossotti C, Elena Vasario, Vasario E, Borgarello V, Valentina Borgarello, Daidola G, Germana Daidola, Martina Ferraresi, Ferraresi M, Pietro Gaglioti, Gaglioti P, Tullia Todros, Todros T
Clinical journal of the American Society of Nephrology : CJASN · 2013 · vol. 8(1) , pp. 41–50 · doi:10.2215/cjn.02550312 · PMID:23124785 · PMC3531652
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This study found that multiple pregnancies in early chronic kidney disease patients face significantly higher risks of preterm delivery, small for gestational age infants, and neonatal mortality compared to low-risk twin pregnancies.

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This study investigated the risks associated with multiple pregnancies in patients with chronic kidney disease by comparing outcomes against low-risk controls. The researchers analyzed data from 20 multiple pregnancies in CKD patients alongside larger control groups to assess adverse events such as preterm delivery and neonatal mortality. Results indicated that early-stage CKD significantly increased the risk of complications, including premature birth, small for gestational age infants, and perinatal death compared to healthy twins. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

BACKGROUND 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 (2000-2011), 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; P=0.010) and proteinuria (0.81 to 3.42 g/d; P=0.041) 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%; P=0.005; <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%; P=0.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P=0.032). CONCLUSION: This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages.
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Background

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 (2000–2011), 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; P=0.010) and proteinuria (0.81 to 3.42 g/d; P=0.041) 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%; P=0.005; <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%; P=0.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P=0.032).

Conclusion

This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages.

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MeSH descriptors

Pregnancy Complications Pregnancy, Multiple Pregnancy Outcome Pregnancy, Twin Renal Insufficiency, Chronic Adult Female Humans Hypertension, Pregnancy-Induced Hypertension, Pregnancy-Induced Italy Italy Logistic Models Multivariate Analysis Pre-Eclampsia Pre-Eclampsia Pregnancy Pregnancy Complications Pregnancy, Multiple Pregnancy Outcome

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