Abstract: TH-OR026

Renal Complications during Pregnancy Before and After Glomerulonephropathy Diagnosis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Oliverio, Andrea L., University of Michigan, Ann Arbor, Michigan, United States
  • Reynolds, Monica Lona, University of North Carolina, Chapel Hill, North Carolina, United States
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
  • O'Shaughnessy, Michelle M., Stanford University Medical Center, Palo Alto, California, United States
  • Zee, Jarcy, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Hladunewich, Michelle A., University of Toronto, Toronto, Ontario, Canada
Background

Pregnancy studies in women with glomerulonephropathy (GN) are limited to single centers and small samples. Delineating pregnancy-associated risks would better inform counseling and determine safe management strategies.

Methods

CureGN is an ongoing 64-center prospective cohort study of children and adults with biopsy-proven MCD, FSGS, MN, or IgAN/IgAV. Patient-reported pregnancy outcomes and maternal/fetal complications are collected at each study visit. Descriptive statistics were used to assess complications of pregnancies before and after GN diagnosis. Among pregnancies prior to diagnosis, a generalized estimating equation model was fit to compare time to diagnosis for those with and without pregnancy complications.

Results

As of May 2017, 273 out of 427 adult women enrolled in CureGN reported 585 pregnancies prior to GN diagnosis and 30 after diagnosis, excluding elective terminations. Of pregnancies after GN diagnosis, 13.3% were in women with MCD, 40% FSGS, 13.3% MN, 33.3% IgAN. Of those with pregnancies prior to GN diagnosis, 12.5% reported increasing proteinuria, 5.8% worsening kidney function, 11.7% worsening blood pressure and 88.5% full term delivery compared to 48.1%, 35.7%, 25.9 % and 57.1%, respectively among pregnancies after diagnosis. Women with pregnancy complications prior to diagnosis had a significantly shorter time between pregnancy and subsequent GN diagnosis than those with uncomplicated pregnancies (Figure).

Conclusion

Pregnancies in women with GN diagnosis had high rates of maternal/fetal complications, necessitating high-risk care. Decreased latency between complicated pregnancies and subsequent GN diagnosis suggests that diagnosis may have been missed during pregnancy or that the physiologic stress of pregnancy may have unmasked a smoldering glomerular disease. While currently at 73% of target enrollment, CureGN is projected to be the largest multi-center international cohort poised to study pregnancy outcomes in women with GN.

Funding

  • NIDDK Support