Emily W Harville1, Janet Catov2, C Elizabeth Lewis3, Kirsten Bibbins-Domingo4, Erica P Gunderson5. 1. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States. Electronic address: harville@tulane.edu. 2. University of Pittsburgh, Departments of OB/GYN and Epidemiology, Pittsburgh, PA, United States. Electronic address: catovjm@mail.magee.edu. 3. Department of Epidemiology, School of Public Health University of Alabama at Birmingham, Birmingham, AL, United States. Electronic address: celewis@uabmc.edu. 4. Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, United States. Electronic address: kirsten.bibbins-domingo@ucsf.edu. 5. Cardiovascular and Metabolism Section, Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States. Electronic address: erica.gunderson@kp.org.
Abstract
BACKGROUND: Renal insufficiency is associated with pregnancy complications including fetal growth restriction, preterm birth (PTB), and pre-eclampsia. OBJECTIVE: To determine the effect of preconception kidney function within the normal range on pregnancy outcome. METHOD: 1043 (50% black, 50% white) women who participated in the CARDIA study who had kidney function and biochemical analyses measured before at least one pregnancy delivered during the 20 years post-baseline period were included in analysis. Kidney function estimated as glomerular filtration rate (eGFR) via modified CKD-EPI equations, serum creatinine, and urinary albumin/creatinine ratio were evaluated as predictors of infant birthweight, gestational age, birthweight-for-gestational-age, and hypertensive disorders of pregnancy via self-report, using multiple regression with adjustment for confounders (age, race, smoking, BMI, center, parity, systolic blood pressure at baseline). Serum uric acid was also examined at both baseline and year 10. RESULTS: Unadjusted pre-pregnancy eGFR (baseline) was associated with lower average birthweight-for-gestational-age, but this disappeared after adjustment for confounders. A decline in GFR from baseline to year 10 was associated with lower birthweight (adjusted estimate -195 g, p = 0.03 overall), especially among whites. After adjustment for confounders, no association was found with gestational age or hypertensive disorders. CONCLUSIONS: No strong evidence for an association between preconception kidney function in the normal range and birthweight or gestational age was found. Possible racial differences in these relationships warrant further examination.
BACKGROUND: Renal insufficiency is associated with pregnancy complications including fetal growth restriction, preterm birth (PTB), and pre-eclampsia. OBJECTIVE: To determine the effect of preconception kidney function within the normal range on pregnancy outcome. METHOD: 1043 (50% black, 50% white) women who participated in the CARDIA study who had kidney function and biochemical analyses measured before at least one pregnancy delivered during the 20 years post-baseline period were included in analysis. Kidney function estimated as glomerular filtration rate (eGFR) via modified CKD-EPI equations, serum creatinine, and urinary albumin/creatinine ratio were evaluated as predictors of infant birthweight, gestational age, birthweight-for-gestational-age, and hypertensive disorders of pregnancy via self-report, using multiple regression with adjustment for confounders (age, race, smoking, BMI, center, parity, systolic blood pressure at baseline). Serum uric acid was also examined at both baseline and year 10. RESULTS: Unadjusted pre-pregnancy eGFR (baseline) was associated with lower average birthweight-for-gestational-age, but this disappeared after adjustment for confounders. A decline in GFR from baseline to year 10 was associated with lower birthweight (adjusted estimate -195 g, p = 0.03 overall), especially among whites. After adjustment for confounders, no association was found with gestational age or hypertensive disorders. CONCLUSIONS: No strong evidence for an association between preconception kidney function in the normal range and birthweight or gestational age was found. Possible racial differences in these relationships warrant further examination.
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