Kidney medicine · 2025
Health Care Utilization Among Pregnant Women With Pre-existing Kidney Disease: A Retrospective Cohort Analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Gupta Sonali, Vasa Aastha, Rizzolo Katherine, Cervantes Lilia, Jim Belinda, Vani Kavita, Wolfe Diana, Isaac Jaya, Reidy Kimberly, Golestaneh Ladan
Аннотация
RATIONALE & OBJECTIVE: Pregnant women with prepregnancy chronic kidney disease (CKD) are underdiagnosed and experience adverse outcomes. Limited research exists on peripregnancy health care utilization by women with evidence of CKD.
STUDY DESIGN: Retrospective cohort analysis.
SETTING & PARTICIPANTS: Women with laboratory signs of prepregnancy CKD who had a pregnancy event between January 1, 2016, and March 1, 2023, at Montefiore Health System in Bronx, NY, were included.
EXPOSURE & OUTCOMES: We investigated rates of CKD diagnosis, adverse maternal and fetal outcomes, and peripregnancy health care utilization among a sample of women with evidence of prepregnancy CKD.
ANALYTICAL APPROACH: We tested the proportion of women with laboratory signs of CKD who had a diagnosis code for CKD entered on their problem list. We also examined the association of different eGFR/proteinuria cutoffs among the cohort with (1) adverse pregnancy outcomes, (2) postpregnancy CKD prevalence, and (3) peripregnancy health utilization.
RESULTS: Of the 247 pregnant women who met criteria for prepregnancy CKD by estimated glomerular filtration rate (eGFR) or proteinuria, 8.1% had spontaneous abortion, 10.9% had missed abortion, 12.9% had CKD listed in problem list. Out of 80.9% of pregnancy that reached fetal viability, 12.5% had early preterm delivery, 22.6% developed gestational hypertension, and 20.0% of their infants required neonatal intensive care unit admission, with worse outcomes seen in those with severe CKD (defined as eGFR < 45 mL/min/1.73 m2 or proteinuria > 1,000 mg/g). Among women with CKD, 27.6% were seen by primary care within 1 year before pregnancy while less than 0.1% were ever seen by a nephrologist. Among women with severe CKD, only 40% were seen by nephrology during pregnancy, and less than 50% had a nephrology appointment arranged at discharge.
LIMITATIONS: Retrospective analysis of a single-center data source.
CONCLUSIONS: Pregnant women with CKD were frequently underdiagnosed and not sufficiently integrated into care before, during, or after pregnancy.
STUDY DESIGN: Retrospective cohort analysis.
SETTING & PARTICIPANTS: Women with laboratory signs of prepregnancy CKD who had a pregnancy event between January 1, 2016, and March 1, 2023, at Montefiore Health System in Bronx, NY, were included.
EXPOSURE & OUTCOMES: We investigated rates of CKD diagnosis, adverse maternal and fetal outcomes, and peripregnancy health care utilization among a sample of women with evidence of prepregnancy CKD.
ANALYTICAL APPROACH: We tested the proportion of women with laboratory signs of CKD who had a diagnosis code for CKD entered on their problem list. We also examined the association of different eGFR/proteinuria cutoffs among the cohort with (1) adverse pregnancy outcomes, (2) postpregnancy CKD prevalence, and (3) peripregnancy health utilization.
RESULTS: Of the 247 pregnant women who met criteria for prepregnancy CKD by estimated glomerular filtration rate (eGFR) or proteinuria, 8.1% had spontaneous abortion, 10.9% had missed abortion, 12.9% had CKD listed in problem list. Out of 80.9% of pregnancy that reached fetal viability, 12.5% had early preterm delivery, 22.6% developed gestational hypertension, and 20.0% of their infants required neonatal intensive care unit admission, with worse outcomes seen in those with severe CKD (defined as eGFR < 45 mL/min/1.73 m2 or proteinuria > 1,000 mg/g). Among women with CKD, 27.6% were seen by primary care within 1 year before pregnancy while less than 0.1% were ever seen by a nephrologist. Among women with severe CKD, only 40% were seen by nephrology during pregnancy, and less than 50% had a nephrology appointment arranged at discharge.
LIMITATIONS: Retrospective analysis of a single-center data source.
CONCLUSIONS: Pregnant women with CKD were frequently underdiagnosed and not sufficiently integrated into care before, during, or after pregnancy.