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.