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). 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. 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). 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.

中文翻译：

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有早产史的女性长期肾脏疾病的风险：一项基于人群的队列研究。

早产是孕产妇心血管疾病的独立危险因素。早产与孕妇肾功能之间的关系知之甚少。这项研究旨在检查经历早产的妇女是否有更高的罹患慢性肾脏病（CKD）和终末期肾脏病（ESKD）的风险。使用瑞典医疗出生登记簿中的数据，确定了1973年至2012年的单胎活产，并将其与瑞典肾脏登记簿和国家患者登记簿中的数据（至2013年）相关联。分娩时的胎龄是主要暴露因素，并被视为随时间变化的变量。主要结局为孕妇CKD或ESKD。使用Cox比例风险回归模型进行分析。数据集包括1,943,716名妇女，其中有3,760,429例单胎活产。中位随访时间为20.6年（四分位间距9.9-30.0）年。总共有162,918名妇女（8.4％）分娩了至少1名早产儿（<37周）。与那些早产的妇女相比，早产（<37周）的妇女患CKD（调整后的危险比（aHR）1.39，95％CI 1.32-1.45）和ESKD（aHR 2.22，95％CI 1.90-1.58）的风险更高。仅在足月（≥37周）分娩。分娩极端早产婴儿（<28周）的妇女患CKD（aHR 1.84，95％CI 1.52–2.22）和ESKD（aHR 3.61，95％CI 2.03–6.39）的风险增加。CKD和ESKD的最高风险发生于早产+先兆子痫的妇女（相对于非先兆子痫足月分娩，CKD的aHR 2.81，95％CI 2.46–3.20； ESKD的aHR 6.70，95％CI 4.70–9.56 ）。但是，自然早产也与CKD风险增加相关（aHR 1.32，95％CI 1.25-1.39）和ESKD（aHR 1.99，95％CI 1.67-2.38）与子痫前期无关，或对于胎龄较小（SGA）。有早产史的妇女罹患CKD和ESKD的风险增加。在早产或极早分娩或早产已在医学上表明的妇女中，风险较高。自发性早产的妇女患子痫前期或SGA的长期肾脏疾病风险增加。早产可能是孕妇肾结局不良的危险标志。或医学上已指示其早产。自发性早产的妇女患子痫前期或SGA的长期肾脏疾病风险增加。早产可能是孕妇肾结局不良的危险标志。或医学上已指示其早产。自发性早产的妇女患子痫前期或SGA的长期肾脏疾病风险增加。早产可能是孕妇肾结局不良的危险标志。