Objective

Limited evidence exists on the role that the cause of chronic kidney disease plays in determining pregnancy outcomes. The aim of this systematic review and meta-analysis was to examine the association between chronic kidney disease and adverse pregnancy outcomes by the cause and severity of chronic kidney disease where reported. The protocol was registered under the International Prospective Register of Systematic Reviews (CRD42020211925).

Data Sources

PubMed, Embase, and Web of Science were searched until May 24, 2021, supplemented with reference list checking.

Study Eligibility Criteria

Studies that compared the pregnancy outcomes in women with or without chronic kidney disease were included. Two reviewers independently screened titles, abstracts, and full-text articles according to a priori defined inclusion criteria.

Methods

Data extraction and quality appraisal were performed independently by 3 reviewers. The grading of recommendations, assessment, development, and evaluation approach was used to assess the overall certainty of the evidence. Random-effects meta-analyses were used to calculate the pooled estimates using the generic inverse variance method. The primary outcomes included preeclampsia, cesarean delivery, preterm birth (<37 weeks’ gestation), and small for gestational age babies.

Results

Of 4076 citations, 31 studies were included. Prepregnancy chronic kidney disease was significantly associated with a higher odds of preeclampsia (pooled crude odds ratio, 8.13; [95% confidence interval, 4.41–15], and adjusted odds ratio, 2.58; [1.33–5.01]), cesarean delivery (adjusted odds ratio, 1.65; [1.21–2.25]), preterm birth (adjusted odds ratio, 1.73; [1.31–2.27]), and small for gestational age babies (adjusted odds ratio, 1.93; [1.06–3.52]). The association with stillbirth was not statistically significant (adjusted odds ratio, 1.67; [0.96–2.92]). Subgroup analyses indicated that different causes of chronic kidney disease might confer different risks and that the severity of chronic kidney disease is associated with a risk of adverse pregnancy outcomes, as pregnancies with later stages of chronic kidney disease had higher odds of preeclampsia, preterm birth, and small for gestational age babies than those at earlier stages. The grading of recommendations, assessment, development, and evaluation certainty of the evidence overall was “very low”.

Conclusion

This meta-analysis quantified the associations between prepregnancy chronic kidney disease and adverse pregnancy outcomes, both overall and according to the cause and severity of the disease. These findings might support the clinicians aiming to counsel women having chronic kidney disease by allowing them to tailor their advice according to cause and severity of the chronic kidney disease. We identified the gaps in the literature, and further studies examining the effect of specific kidney diseases and other clinical characteristics (eg, proteinuria, hypertension) on adverse pregnancy outcomes are warranted.

中文翻译：

---

慢性肾病和不良妊娠结局：系统评价和荟萃分析

客观的

关于慢性肾病病因在确定妊娠结局中的作用的证据有限。本系统评价和荟萃分析的目的是通过报告的慢性肾病的原因和严重程度来检查慢性肾病与不良妊娠结局之间的关系。该方案已在国际系统评价前瞻性登记册 (CRD42020211925) 下注册。

数据源

PubMed、Embase 和 Web of Science 的检索截止日期为 2021 年 5 月 24 日，并辅以参考文献检查。

学习资格标准

纳入了比较患有或不患有慢性肾病的女性的妊娠结局的研究。两名评审员根据先验定义的纳入标准独立筛选标题、摘要和全文文章。

方法

数据提取和质量评价由3名评价者独立进行。建议分级、评估、发展和评价方法用于评估证据的整体确定性。随机效应荟萃分析用于使用通用逆方差方法计算汇总估计值。主要结局包括先兆子痫、剖宫产、早产（<37 孕周）和小于胎龄儿。

结果

在 4076 篇引文中，纳入了 31 项研究。孕前慢性肾脏病与先兆子痫的较高几率显着相关（汇总粗比值比，8.13；[95% 置信区间，4.41-15]，调整比值比，2.58；[1.33-5.01]），剖宫产（调整优势比，1.65；[1.21–2.25]），早产（调整优势比，1.73；[1.31–2.27]）和小于胎龄儿（调整优势比，1.93；[1.06–3.52]）。与死产的关联没有统计学意义（调整优势比，1.67；[0.96–2.92]）。亚组分析表明，慢性肾脏病的不同原因可能带来不同的风险，慢性肾脏病的严重程度与不良妊娠结局的风险相关，因为与早期阶段相比，患有慢性肾病晚期的妊娠具有更高的先兆子痫、早产和小于胎龄儿的几率。整体证据的推荐、评估、开发和评价确定性的等级为“非常低”。

结论

这项荟萃分析量化了孕前慢性肾病与不良妊娠结局之间的关联，无论是总体上还是根据疾病的原因和严重程度。这些发现可能支持旨在为患有慢性肾病的女性提供咨询的临床医生，允许她们根据慢性肾病的病因和严重程度来定制建议。我们确定了文献中的空白，需要进一步研究检查特定肾脏疾病和其他临床特征（例如蛋白尿、高血压）对不良妊娠结局的影响。