Abstract: TH-PO1039
Severe Maternal Morbidity and Long-Term Kidney Outcomes Among Pregnant Persons Receiving Maintenance Dialysis: A National Study
Session Information
- Women's Health and Kidney Diseases
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Kucirka, Lauren M., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Boggess, Kim, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Wood, Mollie Elizabeth, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
- Quist-Nelson, Johanna, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Derebail, Vimal K., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Flythe, Jennifer E., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Chalem, Andrea, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
- Manuck, Tracy, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Meyer, Michelle L., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Reynolds, Monica Lona, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
Background
Pregnant persons receiving maintenance dialysis are at high risk for adverse pregnancy outcomes. Severe maternal morbidity (SMM) occurs in 1.4% of the general US birthing population, but little is known about the rate of SMM in dialysis patients, or its association with long-term renal outcomes.
Methods
Our study included persons who gave birth while receiving maintenance dialysis from 2000-2020 as captured in USRDS. We used linked Medicare claims to identify SMM as defined by the CDC from 4 weeks prior to birth to 6 weeks postpartum. Multivariable Cox proportional hazards models were built to examine the relationship between SMM and 1) mortality, 2) kidney transplant.
Results
Among 1,082 births from 986 individuals, non-renal SMM was present in 31.6%. The most common SMM events were blood transfusion (16.4%), pulmonary edema/acute heart failure (10.4%), sepsis (5.8%), and acute respiratory distress syndrome(5.1%). Risk factors for SMM included Black or Other/unknown race, BMI>35kg/m^2, and dialysis initiation <1 year before giving birth. Patients with SMM had a higher 10 year mortality risk (aHR=1.84, 95% CI:1.39-2.44) and were less likely to receive a kidney transplant(aSHR=0.74, 95% CI: 0.57-0.96, Figure).
Conclusion
Pregnant persons receiving maintenance dialysis have markedly higher rates of SMM compared to the general US birthing population. History of SMM was associated with higher mortality and a longer time to kidney transplant, highlighting the potential for long-term adverse kidney outcomes after a high-risk pregnancy. This information is vital for both the patient and provider for preconception counseling.