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BMC Medicine
Published in: BMC Medicine 1/2020

01-12-2020 | Pre-Eclampsia | Research article

Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study

Authors: Peter M. Barrett, Fergus P. McCarthy, Marie Evans, Marius Kublickas, Ivan J. Perry, Peter Stenvinkel, Karolina Kublickiene, Ali S. Khashan

Published in: BMC Medicine | Issue 1/2020

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Abstract

Background

Preterm delivery is an independent risk factor for maternal cardiovascular disease. Little is known about the association between preterm delivery and maternal renal function. This study aimed to examine whether women who experience preterm delivery are at increased risk of subsequent chronic kidney disease (CKD) and end-stage kidney disease (ESKD).

Methods

Using data from the Swedish Medical Birth Register, singleton live births from 1973 to 2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Gestational age at delivery was the main exposure and treated as a time-dependent variable. Primary outcomes were maternal CKD or ESKD. Cox proportional hazard regression models were used for analysis.

Results

The dataset included 1,943,716 women who had 3,760,429 singleton live births. The median follow-up was 20.6 (interquartile range 9.9–30.0) years. Overall, 162,918 women (8.4%) delivered at least 1 preterm infant (< 37 weeks). Women who had any preterm delivery (< 37 weeks) were at increased risk of CKD (adjusted hazard ratio (aHR) 1.39, 95% CI 1.32–1.45) and ESKD (aHR 2.22, 95% CI 1.90–2.58) compared with women who only delivered at term (≥ 37 weeks). Women who delivered an extremely preterm infant (< 28 weeks) were at increased risk of CKD (aHR 1.84, 95% CI 1.52–2.22) and ESKD (aHR 3.61, 95% CI 2.03–6.39). The highest risk of CKD and ESKD was in women who experienced preterm delivery + preeclampsia (vs. non-preeclamptic term deliveries, for CKD, aHR 2.81, 95% CI 2.46–3.20; for ESKD, aHR 6.70, 95% CI 4.70–9.56). However, spontaneous preterm delivery was also associated with increased risk of CKD (aHR 1.32, 95% CI 1.25–1.39) and ESKD (aHR 1.99, 95% CI 1.67–2.38) independent of preeclampsia or small for gestational age (SGA).

Conclusions

Women with history of preterm delivery are at increased risk of CKD and ESKD. The risk is higher among women who had very preterm or extremely preterm deliveries, or whose preterm delivery was medically indicated. Women who experience spontaneous preterm delivery are at increased risk of long-term renal disease independent of preeclampsia or SGA. Preterm delivery may act as a risk marker for adverse maternal renal outcomes.
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Metadata
Title
Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study
Authors
Peter M. Barrett
Fergus P. McCarthy
Marie Evans
Marius Kublickas
Ivan J. Perry
Peter Stenvinkel
Karolina Kublickiene
Ali S. Khashan
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-020-01534-9

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