Adverse Pregnancy Outcomes in Women with Chronic Kidney Disease: An Updated Systematic Review and Meta-analysis
Keywords:
chronic kidney disease meta-analysis, pregnancy, pre-eclampsia, preterm birthAbstract
Chronic kidney disease (CKD) is increasingly common in women of reproductive age, and its effect on pregnancy warrants updated quantification..PubMed, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials were searched from 1 January 2023, extending the anchor review without language restriction. We included observational studies comparing maternal and perinatal outcomes between women with and without CKD, Two reviewers independently screened and extracted data. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using random-effects models (DerSimonian and Laird).
Twenty-five studies were included (six new, 19 from the original review). CKD was associated with higher odds of every outcome: pre-eclampsia (OR 5.77, 95% CI 3.53 to 9.44), early preterm birth before 34 weeks (OR 7.27, 4.83 to 10.95), gestational hypertension (OR 4.63, 2.78 to 7.68), neonatal intensive care admission (OR 4.10, 2.50 to 6.73), preterm birth before 37 weeks (OR 3.46, 2.60 to 4.61), small-for-gestational-age infants (OR 2.48, 1.86 to 3.30), perinatal mortality (OR 2.40, 1.51 to 3.81) and caesarean section (OR 1.75, 1.54 to 1.99). Risks were greater in diabetic kidney disease.
CKD substantially increases the odds of adverse maternal and perinatal outcomes and should be managed as a high-risk condition with structured preconception counselling and multidisciplinary care.
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