A JEYARUBAN1, R SHANMUGALINGAM1,2,3,4, P WU1,R CAO1,V WONG4,5,T WONG3,4,6, J FLACK3,4,6, A MAKRIS1,2,3,4
1Department of Renal Medicine, Liverpool Hospital, SWSLHD, Sydney, Australia, 2Women’s Health Initiative Translational Research Unit (WHITU), Ingham Institute, SWSLHD, Sydney, Australia, 3School of Medicine, Western Sydney University, Sydney, Australia, 4South Western Sydney Clinical School), University of New South Wales, Sydney, Australia, 5Department of Endocrinology, Liverpool Hospital SWSLHD, Sydney, Australia, 6Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, SWSLHD, Sydney, Australia
Aim: To examine the pregnancy and outcomes of women with pre-gestational diabetes mellitus (PGDM) with concurrent pre-gestational renal impairment.
Background: Pregnant women with pre-pregnancy renal impairment are known to have worse obstetric outcomes with an increased risk of accelerated decline in renal function.
Method: A retrospective audit of data from pregnant women with PGDM from 2 centres in South-Western Sydney from January 2005 to June 2020 was conducted. Data were obtained from a district-wide electronic database and hospital medical records. The outcomes examined were preeclampsia, pre-term delivery (less than 37 weeks) as well as progression to dialysis during and after pregnancy. Women with renal impairment were defined as having a first trimester serum creatinine >80µmol/L whilst well.
Results: In this cohort of 494 women with pre-gestational diabetes, 11(2.5%) women were noted to have serum creatinine of >80µmol/L in their first antenatal review (1st or 2nd trimester). There were no significant statistical differences in the age, body mass index, pre-pregnancy HbA1c, and prophylactic aspirin or calcium use between women with and without pre-gestational renal impairment. However, women with renal impairment had a higher rate of previous preeclampsia (32(7.5%) vs 3(27.3%),p=<0.05) compared to women with no renal impairment. There was a significantly higher rate of preeclampsia (36% vs 12%,p<0.05), and preterm delivery ( 60% vs 24.8%,p<0.05) in women with pre-pregnancy renal impairment. Of the 11 women, 1 woman required dialysis during pregnancy and subsequently died 1 month later.
Conclusion: Women with pre-gestational renal impairment were observed to have worse obstetric outcomes. A larger study with significant follow-up would be beneficial in determining the incidence of progression of renal disease in these women in the post-partum period.
Andrew Jeyaruban is a second year renal advanced trainee at Liverpool Hospital. He graduated from James Cook University and then did his training at Royal Brisbane hospital and Liverpool hospital. He has special interest in renal genetics, renal supportive care and obstetric medicine.