Multiple pregnancies in CKD patients: an explosive mix.
Giorgina Barbara Piccoli, Silvana Arduino, Rossella Attini, Silvia Parisi, Federica Fassio, Marlisa Biolcati, Arianna Pagano, Carlotta Bossotti, Elena Vasario, Valentina Borgarello, Germana Daidola, Martina Ferraresi, Pietro Gaglioti, Tullia Todros
Clinical journal of the American Society of Nephrology : CJASN 2013 JanCKD 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. 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. 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). This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages.
Citation
Giorgina Barbara Piccoli, Silvana Arduino, Rossella Attini, Silvia Parisi, Federica Fassio, Marlisa Biolcati, Arianna Pagano, Carlotta Bossotti, Elena Vasario, Valentina Borgarello, Germana Daidola, Martina Ferraresi, Pietro Gaglioti, Tullia Todros. Multiple pregnancies in CKD patients: an explosive mix. Clinical journal of the American Society of Nephrology : CJASN. 2013 Jan;8(1):41-50
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PMID: 23124785
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