Obstetric Outcomes in Pregnancies Complicated by Pre-existing Maternal Diabetes According to Indicators of Diabetic Kidney Disease.  — ASN Events
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Obstetric Outcomes in Pregnancies Complicated by Pre-existing Maternal Diabetes According to Indicators of Diabetic Kidney Disease.  (#203)

Jas-mine Seah 1 2 3 , Ning Mao Kam 2 3 , Lydia Wong 2 , George Jerums 2 3 , Michael Permezel 1 3 , Leonid Churilov 3 , Alexis Shub 1 3 , Chris Houlihan 1 2 , Elif I. Ekinci 2 3
  1. Mercy Hospital For Women, Melbourne, VIC
  2. Endocrinology, Austin Health, Heidelberg, VIC, Australia
  3. University of Melbourne, Carlton, VIC

Introduction:

Adverse obstetric outcomes have been linked to the presence of diabetic kidney disease (DKD). We conducted a 10-year retrospective study of a single major tertiary hospital exploring obstetric outcomes in women with pre-existing diabetes according to indicators of DKD; reduced eGFR ±albuminuria.

Methods:

Clinical and biochemical characteristics of women with Type 1 (T1DM) (n=93) and Type 2 Diabetes (T2DM) (n=106) who delivered at Mercy Hospital for Women between 2004-2014 were recorded. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Cohort formula (eGFR). Stages of DKD were defined as Hyperfiltering, eGFR > 120ml/min/1.73m2; Stage 1, 90-120ml/min/1.73m2; Stage 2+, <90ml/min/1.73m2. Albuminuria was determined using albumin creatinine ratio (ACR). Multivariable logistic regression models were formulated for major obstetric outcomes as the dependent variables and renal status (either eGFR or ACR), blood pressure, HbA1c, age, type of diabetes, and BMI as independent variables throughout pregnancy.

Results:

Compared to women with normoalbuminuria (n=109), women with microalbuminuria and macroalbuminuria showed higher proportion of pre-eclampsia, pre-term birth <32 or 37 weeks, small for gestational age and neonatal intensive care (Table). Using multivariable analysis, albuminuria was associated with higher risk of pre-eclampsia (OR5.2, 95CI 2.2-12.0, p=<0.001 pre-term birth <32 weeks (OR2.7, 95CI 1.1-6.3, p=0.02), and neonatal intensive care (OR1.9, 95CI 1.0-3.5, p=0.04).

When categorised by stages of DKD, compared to women with hyperfiltration(n=122), women with both stage 1 and stage 2+ DKD had higher risk of pre-eclampsia. There was an additional risk of neonatal intensive care admission and pre-term birth (<32 and <37 weeks)in the Stage 2+ DKD women (Figure). Following multivariable analysis, the association of eGFR with these outcomes persisted. For every 1ml/min/1.73m2 reduction in mean eGFR, the odds of developing pre-eclampsia increased by the factor of 1.04 (p=0.01, 95CI 1.01-1.07) and 1.04 for pre-term birth <32weeks (p=0.01, 95CI 1.01-1.07).

2198-ADS%20DKD%20Table.jpg

Conclusion:

This study has provided additional evidence for the association of adverse pregnancy outcomes in pregnant women with pre–existing diabetes according to albuminuria status as well as eGFR level. Despite recognition of the limitations of eGFR underestimating physiologic pregnancy hyperfiltration, lower eGFR values were associated with increased risk of adverse outcomes.