Abstract: TH-PO1008
Multiple Gestations in Women Living with CKD: Risk Assessment and Hints for Counselling
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
- Gianferrari, Matteo, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
- Mariani, Chiara, Umberto I Policlinico di Roma, Rome, Lazio, Italy
- Carta, Simona, Universita degli Studi di Cagliari, Cagliari, Sardinia, Italy
- Torreggiani, Massimo, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
- Chatrenet, Antoine, Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
- Cabiddu, Gianfranca, Universita degli Studi di Cagliari, Cagliari, Sardinia, Italy
- Rocca, Anna Rachele, Umberto I Policlinico di Roma, Rome, Lazio, Italy
- Piccoli, Giorgina B., Centre Hospitalier du Mans, Le Mans, Pays de la Loire, France
Background
Chronic kidney disease (CKD) is an acknowledged risk factor for adverse pregnancy outcomes (APOs), but little is known on multiple pregnancies, by themselves associated with a higher risk of APOs. Due to increasing maternal age and diffusion of medically assisted fertilization, multiple pregnancies are increasing. The aim of this study was to review pregnancy outcomes in the largest available multicentre series of multiple pregnancies in women with CKD, compared to low-risk multiple pregnancies and singleton pregnancies.
Methods
The study included data from three Italian units with long-standing experience in follow-up of pregnancy in women with CKD (2000-2023). Multiple low-risk pregnancies and singleton pregnancies recorded in the same settings served as controls (propensity score matched for age, parity, BMI, year of delivery; multiple pregnancies were also matched for chorionicity, aminionicity and mode of conception). Time to delivery was analysed by Kaplan Meier and Cox analysis, while preterm delivery, small for gestational age (SGA), neonatal intensive care unit (NICU) admission were analysed by univariable and multivariable analysis. Intrauterine death of at least one fetus, due to few events, was explored in the overall cohorts.
Results
Multiple pregnancies in women with CKD were associated with a significantly lower gestational age compared to low-risk controls (median 34.0 vs 36.0 weeks), with lower term delivery rate (9.6% vs 28.8%). These findings were consistent across sub-analyses, including the cohort of twins from mothers with CKD stage 1. NICU admission was more frequent in multiple pregnancies with CKD (50.9% vs 25.2% with a Fisher exact p = 0.003608).
Cox regression and Kaplan–Meier analyses confirmed the independent impact of CKD on gestational duration. Among pregnancies in women with CKD, twins had a markedly shorter gestation than singletons (median 34 vs 39 gestational weeks-GW, Mann-Whitney p < 0.00001), with higher risk of preterm birth <34 GW (OR 9.733), SGA (OR 5.155), and NICU admission (OR 8.033). The difference was sharper then in low-risk pregnancies (35 vs 39 GW).
Conclusion
Twinning acts as a risk multiplier in women with CKD highlighting the need for specific counselling, particularly in the setting of medically assisted reproduction.