Michael Ordon1,2, Jade Dirk2, Justin Slater2, Jamie Kroft3, Stephanie Dixon2,4, Blayne Welk2,4,5. 1. Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada. 2. Institute for Clinical Evaluative Sciences, London, Canada. 3. Department of Obstetrics and Gynecology, Sunnybrook Health Science Centre, Toronto, Canada. 4. Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada. 5. Division of Urology, Department of Surgery, St. Joseph's Health Care, Western University, London, Canada.
Abstract
Purpose: To determine the incidence of kidney stones in pregnancy, the risk of adverse birth outcomes, and treatment trends. Methods: We performed a population-based matched cohort study using Ontario's health care databases. All pregnancies in Ontario from 2004 to 2014 were identified. The study exposure was hospital admission, emergency room visit, or intervention for kidney stones during pregnancy. Each pregnancy with a stone was matched to up to six pregnancies without a stone based on age, region of residence, income quintile, year of cohort entry, prior births, and multibirths. The primary outcome was adverse birth outcome defined as preterm birth, low birth weight, or infant death. Secondary outcomes included premature rupture of membranes (PROM), pre-eclampsia, and cesarean section (C/S), as well as the type/frequency of intervention for stones in pregnancy. Logistic regression models, with generalized estimating equations, were used to assess any differences in study outcomes across groups. Results: Of 1.39 million pregnancies identified, there were 2863 pregnancies with stones (0.2%), which were matched with 17,171 pregnancies without stones. Pregnancies with stones had an increased risk for adverse birth outcome compared with matched pregnancies without stones (odds ratio [OR] 1.62, confidence interval [95% CI] 1.43-1.82, p < 0.0001). Pregnancies with stones also had a greater risk for pre-eclampsia (OR 1.42, 95% CI 1.02-1.99, p = 0.04) and C/S (OR 1.39, 95% CI 1.27-1.51, p < 0.0001), but not PROM. Twenty-six percent of pregnant patients admitted for a stone had an intervention, most commonly a stent or ureteroscopy. Conclusion: Our study demonstrated an increased risk of adverse birth outcomes in pregnancies with kidney stones. These results will be important for counseling pregnant patients with kidney stones and women of reproductive age who are at risk of developing stones.
Purpose: To determine the incidence of kidney stones in pregnancy, the risk of adverse birth outcomes, and treatment trends. Methods: We performed a population-based matched cohort study using Ontario's health care databases. All pregnancies in Ontario from 2004 to 2014 were identified. The study exposure was hospital admission, emergency room visit, or intervention for kidney stones during pregnancy. Each pregnancy with a stone was matched to up to six pregnancies without a stone based on age, region of residence, income quintile, year of cohort entry, prior births, and multibirths. The primary outcome was adverse birth outcome defined as preterm birth, low birth weight, or infantdeath. Secondary outcomes included premature rupture of membranes (PROM), pre-eclampsia, and cesarean section (C/S), as well as the type/frequency of intervention for stones in pregnancy. Logistic regression models, with generalized estimating equations, were used to assess any differences in study outcomes across groups. Results: Of 1.39 million pregnancies identified, there were 2863 pregnancies with stones (0.2%), which were matched with 17,171 pregnancies without stones. Pregnancies with stones had an increased risk for adverse birth outcome compared with matched pregnancies without stones (odds ratio [OR] 1.62, confidence interval [95% CI] 1.43-1.82, p < 0.0001). Pregnancies with stones also had a greater risk for pre-eclampsia (OR 1.42, 95% CI 1.02-1.99, p = 0.04) and C/S (OR 1.39, 95% CI 1.27-1.51, p < 0.0001), but not PROM. Twenty-six percent of pregnant patients admitted for a stone had an intervention, most commonly a stent or ureteroscopy. Conclusion: Our study demonstrated an increased risk of adverse birth outcomes in pregnancies with kidney stones. These results will be important for counseling pregnant patients with kidney stones and women of reproductive age who are at risk of developing stones.
Authors: Charat Thongprayoon; Lisa E Vaughan; Api Chewcharat; Andrea G Kattah; Felicity T Enders; Rajiv Kumar; John C Lieske; Vernon M Pais; Vesna D Garovic; Andrew D Rule Journal: Am J Kidney Dis Date: 2021-04-15 Impact factor: 11.072