ADVERSE PREGNANCY OUTCOMES IN WOMEN WITH KIDNEY DISORDERS – A POPULATION STUDY OF >400,000 PREGNANCIES IN SOUTH AUSTRALIA (SA): 1990–2012

A FITZPATRICK1, B CATCHESIDE2, A NGUYEN2, K VENUGOPAL2, W SCHEIL2,3, SP MCDONALD3,4, S JESUDASON3,4,

1Royal Adelaide Hospital, Adelaide, South Australia; 2SA Pregnancy Outcomes Unit, SA Health, Adelaide, South Australia; 3School of Medicine, University of Adelaide, Adelaide, South Australia; 4Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Adelaide, South Australia

Aim: To describe maternal and perinatal outcomes at a population level for South Australian women with renal disorders.

Background: Renal disease in pregnancy promotes adverse maternal and perinatal outcomes. Population-level data, notably in the Australian context, remain lacking.

Methods: SA Pregnancy Outcomes Unit data for singleton births (19902012) were analysed. Using maternal ICD-9 codes collected at delivery, renal conditions were broadly grouped as vesicoureteral reflux (VUR),  pyelonephritis, immunological, cystic/genetic, and urological conditions. Multivariable and multinomial logistic regression was utilized with covariates selected a priori, including age, ethnicity, socioeconomic status and diabetes.

Results: Of 407,580 women, 0.3% had a renal code ascribed. These women were more likely to be aged <25 years, Indigenous and of lower socioeconomic position. Any renal code in pregnancy was associated with adverse outcome, including hypertensive disorders (OR 2.15, 95%CI 1.82-2.56), induction of labour (RRR 2.10, 95%CI 1.06-1.19), caesarean section (OR 1.31, 95%CI 1.17-1.47), preterm birth <37 weeks (OR 2.76, 95%CI 2.40-3.18), low birth weight <2500g (OR 2.43 95%CI 2.07-2.84) and neonatal ICU admission (OR 2.64 95%CI 2.12-3.29). The greatest risk of adverse outcomes occurred in women with VUR and immunological renal conditions. VUR in particular conferred highest risk of hypertensive disorders (OR 8.57, 95%CI 4.29-17.12) and caesarean section (OR 4.18 95% CI 2.158.12) as well as preterm birth (OR 5.26, 95%CI 2.56-10.22). Immunological renal conditions were associated with increased odds of hypertensive disorders (5.03, 95%CI 2.64-9.60), preterm birth (OR 7.40, 95%CI 4.22-13.00) and low birth weight (OR 6.80 95%CI 3.79, 12.20).

Conclusions: The presence of any renal code was associated with adverse maternal and perinatal outcome, with the greatest risk experienced by women with VUR and immunological renal conditions.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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