Kidney dysfunction before pregnancy may increase risk for pr
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Women with elevated serum creatinine levels before pregnancy may have a greater risk for giving birth pre-term, according to a recent study. “Prepregnancy kidney dysfunction may perturb the normal physiologic adaptations of pregnancy, predisposing a woman and her fetus to adversity, at least partly mediated by placental and endothelial dysfunction,” the researchers explained. “Complications such as preeclampsia and poor fetal growth may necessitate provider-initiated preterm birth. Preterm birth of any form before 37 weeks’ gestation occurs in 6% to 11% of viable pregnancies and is the leading cause of infant death.”

Harel and colleagues assessed 55,946 pregnancies. All participants had a measurement of serum creatinine within 10 weeks preceding their estimated conception date with “abnormally” elevated levels defined as greater than the 95th percentile (> 77 mol/L). According to the researchers, this cutoff was derived from a sample of women without kidney disease who became pregnant shortly after the serum creatinine measurement was obtained. Of total pregnancies, 7.1% occurred pre-term, or before 37 weeks’ gestation. The researchers found that the risk for pre-term birth was higher among women who had pre-pregnancy creatinine levels above the 95th percentile than among those with normal serum creatinine (9.1% vs. 7%; adjusted relative risk = 1.23). The associated risk for severe preterm birth, defined as before 32 weeks’ gestation, was doubled for women with elevated pre-pregnancy serum creatinine levels.

Elaborating on this finding, Harel and colleagues wrote, “Elevated serum creatinine was notably associated with an increased risk for outcomes of a fetus severely small for gestational age and preeclampsia, which may be reasons for the increase in provider-initiated preterm birth but not spontaneous preterm birth.” It may be appropriate in future guidelines to consider the importance of serum creatinine measurement before pregnancy or during the time of prenatal serum screening, especially given the test’s low cost and widespread availability, they concluded.