Journal of Shanghai Jiao Tong University (Medical Science) ›› 2024, Vol. 44 ›› Issue (5): 560-566.doi: 10.3969/j.issn.1674-8115.2024.05.003
• High-risk?pregnancy column • Previous Articles
Received:
2023-03-21
Accepted:
2024-04-18
Online:
2024-05-28
Published:
2024-05-28
Contact:
ZHANG Yu
E-mail:fyyly2326@126.com;rjzhangyu@163.com
CLC Number:
LI Yu, ZHANG Yu. Analysis of risk factors of adverse pregnancy outcomes in patients with chronic kidney disease[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(5): 560-566.
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URL: https://xuebao.shsmu.edu.cn/EN/10.3969/j.issn.1674-8115.2024.05.003
Item | Type of nephritis | |||
---|---|---|---|---|
Chronic nephritis | IgA nephropathy | Lupus nephritis | Nephrotic syndrome | |
Number of delivery/n(%) | 201 (56.94) | 99 (28.05) | 39 (11.05) | 14 (3.97) |
Maternal outcome/n(%) | ||||
PE | 43 (21.39) | 14 (14.14) | 11 (28.21) | 1 (7.14) |
Severe PE | 24 (11.94) | 9 (9.09) | 9 (23.08) | 1 (7.14) |
Acute kidney injury | 13 (6.50) | 10 (10.10) | 3 (7.69) | 3 (21.43) |
Fetal outcome/n(%) | ||||
Fetal loss after 20 weeks | 3 (1.49) | 3 (3.03) | 0 (0) | 1 (7.14) |
Neonatal death | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Preterm birth | 28 (13.93) | 16 (16.16) | 22 (56.41) | 3 (21.43) |
Preterm birth before 34weeks | 9 (4.48) | 7 (7.07) | 10 (25.64) | 3 (21.43) |
LBWI | 18 (8.95) | 9 (9.09) | 17 (43.58) | 2 (14.29) |
SGA | 16 (7.96) | 8 (8.08) | 8 (20.51) | 2 (14.29) |
NICU | 19 (9.45) | 9 (9.09) | 11 (28.20) | 2 (14.29) |
Tab 1 Adverse pregnancy outcome and incidence in patients with chronic kidney disease
Item | Type of nephritis | |||
---|---|---|---|---|
Chronic nephritis | IgA nephropathy | Lupus nephritis | Nephrotic syndrome | |
Number of delivery/n(%) | 201 (56.94) | 99 (28.05) | 39 (11.05) | 14 (3.97) |
Maternal outcome/n(%) | ||||
PE | 43 (21.39) | 14 (14.14) | 11 (28.21) | 1 (7.14) |
Severe PE | 24 (11.94) | 9 (9.09) | 9 (23.08) | 1 (7.14) |
Acute kidney injury | 13 (6.50) | 10 (10.10) | 3 (7.69) | 3 (21.43) |
Fetal outcome/n(%) | ||||
Fetal loss after 20 weeks | 3 (1.49) | 3 (3.03) | 0 (0) | 1 (7.14) |
Neonatal death | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Preterm birth | 28 (13.93) | 16 (16.16) | 22 (56.41) | 3 (21.43) |
Preterm birth before 34weeks | 9 (4.48) | 7 (7.07) | 10 (25.64) | 3 (21.43) |
LBWI | 18 (8.95) | 9 (9.09) | 17 (43.58) | 2 (14.29) |
SGA | 16 (7.96) | 8 (8.08) | 8 (20.51) | 2 (14.29) |
NICU | 19 (9.45) | 9 (9.09) | 11 (28.20) | 2 (14.29) |
Item | Study group (n=123) | Control group (n=230) | P value |
---|---|---|---|
Age/year | 31.22±3.74 | 31.37±3.64 | 0.723 |
BMI/(kg·m-2) | 22.74±3.57 | 21.92±2.89 | 0.058 |
Pregnancy/n | 2 (1, 3) | 2 (1, 2) | 0.268 |
Delivery/n | 0 | 0 | 0.630 |
Chronic hypertension/n(%) | 20 (16.26) | 19 (8.26) | 0.022 |
SBP/mmHg | 123 (115, 132) | 115 (108, 123) | 0.000 |
DBP/mmHg | 79 (71, 86) | 71.5 (66, 80) | 0.000 |
MAP/mmHg | 94 (86, 101) | 86 (80, 93) | 0.000 |
Aspirin/n(%) | 109 (88.61) | 200 (86.96) | 0.653 |
Immunosuppressant/n(%) | 38 (30.89) | 33 (14.35) | 0.000 |
24 h proteinuria≥0.3 g/n(%) | 70 (56.91) | 79 (34.35) | 0.000 |
24 h proteinuria≥2 g/n(%) | 57 (46.34) | 31 (13.48) | 0.000 |
Types of nephritis/n(%) | |||
Chronic nephritis | 68 (55.28) | 133 (57.83) | 0.646 |
IgA nephropathy | 27 (21.95) | 72 (31.30) | 0.062 |
Nephrotic syndrome | 4 (3.25) | 10 (4.35) | 0.615 |
Lupus nephritis | 24 (19.51) | 15 (6.52) | 0.000 |
Tab 2 Comparison of the clinical characteristics before 20 weeks of gestation between the 2 groups
Item | Study group (n=123) | Control group (n=230) | P value |
---|---|---|---|
Age/year | 31.22±3.74 | 31.37±3.64 | 0.723 |
BMI/(kg·m-2) | 22.74±3.57 | 21.92±2.89 | 0.058 |
Pregnancy/n | 2 (1, 3) | 2 (1, 2) | 0.268 |
Delivery/n | 0 | 0 | 0.630 |
Chronic hypertension/n(%) | 20 (16.26) | 19 (8.26) | 0.022 |
SBP/mmHg | 123 (115, 132) | 115 (108, 123) | 0.000 |
DBP/mmHg | 79 (71, 86) | 71.5 (66, 80) | 0.000 |
MAP/mmHg | 94 (86, 101) | 86 (80, 93) | 0.000 |
Aspirin/n(%) | 109 (88.61) | 200 (86.96) | 0.653 |
Immunosuppressant/n(%) | 38 (30.89) | 33 (14.35) | 0.000 |
24 h proteinuria≥0.3 g/n(%) | 70 (56.91) | 79 (34.35) | 0.000 |
24 h proteinuria≥2 g/n(%) | 57 (46.34) | 31 (13.48) | 0.000 |
Types of nephritis/n(%) | |||
Chronic nephritis | 68 (55.28) | 133 (57.83) | 0.646 |
IgA nephropathy | 27 (21.95) | 72 (31.30) | 0.062 |
Nephrotic syndrome | 4 (3.25) | 10 (4.35) | 0.615 |
Lupus nephritis | 24 (19.51) | 15 (6.52) | 0.000 |
Item | Study group (n=123) | Control group (n=230) | P value |
---|---|---|---|
WBC/(×109·L-1) | 9.57±2.62 | 9.19±2.29 | 0.158 |
HB/(g·L-1) | 120.22±18.49 | 123.69±11.71 | 0.061 |
PLT/(×109·L-1) | 237.97±66.47 | 238.05±54.92 | 0.990 |
TSH/(mIU·mL-1) | 1.52 (0.71, 2.74) | 1.31 (0.53, 2.00) | 0.092 |
Serum creatinine/(μmol·L-1) | 58.00 (44.00, 82.00) | 48.25 (42.77, 53.85) | 0.000 |
Proteinuria/[mg·(24 h)-1] | 683 (326, 2 121) | 321 (177, 691) | 0.000 |
Tab 3 Comparison of the laboratory indicators before 20 weeks of gestation between the 2 groups
Item | Study group (n=123) | Control group (n=230) | P value |
---|---|---|---|
WBC/(×109·L-1) | 9.57±2.62 | 9.19±2.29 | 0.158 |
HB/(g·L-1) | 120.22±18.49 | 123.69±11.71 | 0.061 |
PLT/(×109·L-1) | 237.97±66.47 | 238.05±54.92 | 0.990 |
TSH/(mIU·mL-1) | 1.52 (0.71, 2.74) | 1.31 (0.53, 2.00) | 0.092 |
Serum creatinine/(μmol·L-1) | 58.00 (44.00, 82.00) | 48.25 (42.77, 53.85) | 0.000 |
Proteinuria/[mg·(24 h)-1] | 683 (326, 2 121) | 321 (177, 691) | 0.000 |
Item | OR (95% CI) | P value |
---|---|---|
Chronic hypertension | 5.583 (2.124‒14.669) | 0.000 |
Immunosuppressant | 2.669 (1.569‒4.540) | 0.000 |
Serum creatinine >60 μmol/L | 5.136 (3.101‒8.507) | 0.000 |
24 h proteinuria | ||
Proteinuria≥0.3 g | 2.656 (1.419‒4.971) | 0.002 |
Proteinuria≥2 g | 8.033 (3.339‒19.331) | 0.000 |
Types of nephritis | ||
Lupus nephritis: chronic nephritis | 3.129 (1.541‒6.354) | 0.002 |
IgA nephropathy: chronic nephritis | 0.733 (0.432‒1.246) | 0.252 |
Nephrotic syndrome: chronic nephritis | 0.782 (0.237‒2.587) | 0.687 |
Tab 4 Univariate regression analysis of influencing factors of adverse pregnancy outcomes
Item | OR (95% CI) | P value |
---|---|---|
Chronic hypertension | 5.583 (2.124‒14.669) | 0.000 |
Immunosuppressant | 2.669 (1.569‒4.540) | 0.000 |
Serum creatinine >60 μmol/L | 5.136 (3.101‒8.507) | 0.000 |
24 h proteinuria | ||
Proteinuria≥0.3 g | 2.656 (1.419‒4.971) | 0.002 |
Proteinuria≥2 g | 8.033 (3.339‒19.331) | 0.000 |
Types of nephritis | ||
Lupus nephritis: chronic nephritis | 3.129 (1.541‒6.354) | 0.002 |
IgA nephropathy: chronic nephritis | 0.733 (0.432‒1.246) | 0.252 |
Nephrotic syndrome: chronic nephritis | 0.782 (0.237‒2.587) | 0.687 |
Item | OR (95% CI) | P value |
---|---|---|
Chronic hypertension | 3.385 (1.115‒10.726) | 0.031 |
Serum creatinine >60 μmol/L | 2.828 (1.439‒5.557) | 0.003 |
24 h proteinuria | ||
Proteinuria≥0.3 g | 2.234 (1.122‒4.448) | 0.022 |
Proteinuria≥2 g | 4.904 (1.808‒13.303) | 0.002 |
Types of nephritis | ||
Lupus nephritis: chronic nephritis | 4.917 (1.967‒12.290) | 0.001 |
IgA nephropathy: chronic nephritis | 0.745 (0.375‒1.478) | 0.399 |
Nephrotic syndrome: chronic nephritis | 0.764 (0.126‒4.624) | 0.769 |
Tab 5 Multivariate regression analysis of independent risk factors of adverse pregnancy outcomes
Item | OR (95% CI) | P value |
---|---|---|
Chronic hypertension | 3.385 (1.115‒10.726) | 0.031 |
Serum creatinine >60 μmol/L | 2.828 (1.439‒5.557) | 0.003 |
24 h proteinuria | ||
Proteinuria≥0.3 g | 2.234 (1.122‒4.448) | 0.022 |
Proteinuria≥2 g | 4.904 (1.808‒13.303) | 0.002 |
Types of nephritis | ||
Lupus nephritis: chronic nephritis | 4.917 (1.967‒12.290) | 0.001 |
IgA nephropathy: chronic nephritis | 0.745 (0.375‒1.478) | 0.399 |
Nephrotic syndrome: chronic nephritis | 0.764 (0.126‒4.624) | 0.769 |
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