Pregnancy outcome and its relationship to progression of renal failure in autosomal dominant polycystic kidney disease.

The effect of pregnancy on renal disease has not been defined in autosomal dominant polycystic kidney disease (ADPKD). Therefore, fetal and maternal complication rates in ADPKD women as compared with those in unaffected family members (NADPKD) were assessed. Two hundred thirty-five ADPKD and 108 NADPKD women with 605 and 244 pregnancies, respectively, were studied. Overall, fetal complication rates were similar between ADPKD and NADPKD women (32.6 versus 26.2%). Fetal complications were more common in ADPKD women when they were older than 30 yr. Increased fetal prematurity rates were found in preeclamptic ADPKD women as compared with normotensive ADPKD women (28 versus 10%; P < 0.01). More maternal complications occurred in ADPKD as compared with NADPKD women (35 versus 19%; P < 0.001), with preexisting hypertension being the most important risk factor for a maternal complication to occur. Normotensive ADPKD women who developed preeclampsia were more likely to develop chronic hypertension as compared with those without preeclampsia (89 versus 58%; P < 0.01). Hypertensive ADPKD women with four or more pregnancies had lower creatinine clearances than age-adjusted hypertensive ADPKD women with fewer than four pregnancies (49 +/- 5 versus 66 +/- 3 mL/min per 1.73 m2; P < 0.01). Therefore, normotensive ADPKD women usually have successful, uncomplicated pregnancies. However, hypertensive ADPKD women are at high risk for fetal and maternal complications and measures should be taken to prevent the development of preeclampsia in these women.