PREGNANCY OUTCOME AND ITS RELATIONSHIP TO PROGRESSION OF RENAL-FAILURE IN AUTOSOMAL-DOMINANT POLYCYSTIC KIDNEY-DISEASE

The effect of pregnancy on renal disease has not been defined in autos omal dominant polycystic kidney disease (ADPKD). Therefore, fetal and maternal complication rates in ADPKD women as compared with those in u naffected family members (NADPKD) were assessed. Two hundred thirty-fi ve ADPKD and 108 NADPKD women with 605 and 244 pregnancies, respective ly, were studied. Overall, fetal complication rates were similar betwe en ADPKD and NADPKD women (32.6 versus 26.2%). Fetal complications wer e more common in ADPKD women when they were older than 30 yr. Increase d fetal prematurity rates were found in preeclamptic ADPKD women as co mpared with normotensive ADPKD women (28 versus 10%; P < 0.01). More m aternal complications occurred in ADPKD as compared with NADPKD women (35 versus 19%; P < 0.001), with preexisting hypertension being the mo st important risk factor for a maternal complication to occur. Normote nsive ADPKD women who developed preeclampsia were more likely to devel op chronic hypertension as compared with those without preeclampsia (8 9 versus 58%; P < 0.01). Hypertensive ADPKD women with four or more pr egnancies had lower creatinine clearances than age-adjusted hypertensi ve ADPKD women with fewer than four pregnancies (49 +/- 5 versus 66 +/ - 3 mL/min per 1.73 m(2); P < 0.01). Therefore, normotensive ADPKD wom en usually have successful, uncomplicated pregnancies. However, hypert ensive ADPKD women are at high risk for fetal and maternal complicatio ns and measures should be taken to prevent the development of preeclam psia in these women.