Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study
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 subse...
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | BMC Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12916-020-01534-9 |
| _version_ | 1818903311239086080 |
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| author | Peter M. Barrett Fergus P. McCarthy Marie Evans Marius Kublickas Ivan J. Perry Peter Stenvinkel Karolina Kublickiene Ali S. Khashan |
| author_facet | Peter M. Barrett Fergus P. McCarthy Marie Evans Marius Kublickas Ivan J. Perry Peter Stenvinkel Karolina Kublickiene Ali S. Khashan |
| author_sort | Peter M. Barrett |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-19T20:49:31Z |
| format | Article |
| id | doaj.art-e909b3a9b2a54efe86028d2e4c376489 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-19T20:49:31Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-e909b3a9b2a54efe86028d2e4c3764892022-12-21T20:06:08ZengBMCBMC Medicine1741-70152020-04-0118111210.1186/s12916-020-01534-9Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort studyPeter M. Barrett0Fergus P. McCarthy1Marie Evans2Marius Kublickas3Ivan J. Perry4Peter Stenvinkel5Karolina Kublickiene6Ali S. Khashan7School of Public Health, Western Gateway Building, University College CorkIrish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College CorkDivision of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University HospitalDepartment of Obstetrics & Gynaecology, Karolinska University HospitalSchool of Public Health, Western Gateway Building, University College CorkDivision of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University HospitalDivision of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University HospitalSchool of Public Health, Western Gateway Building, University College CorkAbstract 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.http://link.springer.com/article/10.1186/s12916-020-01534-9Preterm deliveryChronic kidney diseaseEnd-stage kidney diseasePregnancyPreeclampsiaEpidemiology |
| spellingShingle | Peter M. Barrett Fergus P. McCarthy Marie Evans Marius Kublickas Ivan J. Perry Peter Stenvinkel Karolina Kublickiene Ali S. Khashan Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study BMC Medicine Preterm delivery Chronic kidney disease End-stage kidney disease Pregnancy Preeclampsia Epidemiology |
| title | Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study |
| title_full | Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study |
| title_fullStr | Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study |
| title_full_unstemmed | Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study |
| title_short | Risk of long-term renal disease in women with a history of preterm delivery: a population-based cohort study |
| title_sort | risk of long term renal disease in women with a history of preterm delivery a population based cohort study |
| topic | Preterm delivery Chronic kidney disease End-stage kidney disease Pregnancy Preeclampsia Epidemiology |
| url | http://link.springer.com/article/10.1186/s12916-020-01534-9 |
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