Asian Journal of Pregnancy and Childbirth

Objective: Advanced obstetric care in pregnancy with chronic kidney disease (CKD) has improved the perinatal outcomes. However, preterm delivery associated with high cost implications and perinatal morbidity is a matter of concern in these women. Better understanding of the risk factors for preterm delivery in these women may further help to improve the outcome by targeted interventions. The objective of our study was to evaluate the maternal and fetal outcomes and identify the risk factors for induced preterm delivery in pregnancy with CKD.

Study Design: It was a retrospective analysis of 57 pregnant women with CKD. Various biochemical and clinical factors were compared between these women with induced preterm delivery and term delivery to find out associated risk factors. P value <0.05 was considered as statistically significant.

Results: Out of 57 women, 39.59%(n=22) had term delivery, 57.89%(n=33) preterm and 3.50%(n=2) women underwent medical termination of pregnancy. The mean age (26.55±4.04 vs 27.36±4.02 years, p=0.46) and body mass index (24.91±3.23 vs 25.48±3.43 kg/m², p=0.53) were similar among term vs preterm group.  Primary glomerulonephritis was commonest cause of CKD in both groups. In term group, 68.2% were stage 1, 27.3% stage 2, 4.5% stage 3 and none of the patient were in stage 4 and 5. In preterm group, 48.5% were stage 1, 3.5% stage 2, 30.3% stage 3 CKD. All women in stage 4 (12.1%) and stage 5 (6.1%) had preterm births. Anaemia (4.5% vs 33.4%, p=0.018) and hypertension (31.8% vs 72.7%, p=0.003) were significantly more in preterm as compared to term group. On univariate analysis, CKD stage ³3(OR 15, 95% CI 1.8-127.4), uric acid (OR 1.7, 95% CI 1.15-2.44), anaemia (OR 10.50,95%CI 1.2-88.5) and hypertension (OR 5.71,95%CI 1.75-18.5) were significant predictors of induced preterm delivery. On multivariate analysis, hypertension and stage of CKD were significant risk factors for induced preterm delivery.

Conclusion: Conception in earlier stage of CKD, correction of anaemia in first trimester and control of hypertension are to be especially focused during preconception counselling and antenatal care of patients with CKD. Early detection of risk factors and timely intervention may reduce induced preterm delivery and improve maternal and fetal outcomes.