PREGNANCY IN WOMEN WITH IMPAIRED RENAL-FUNCTION

The outcome and consequences of pregnancy in women with impaired renal function are still debated. To assess the benefit of recent advances in coordinated obstetrical and nephrologic management, we analyzed fet al and maternal outcome of 43 pregnancies in 30 women with various typ es of primary renal disease and moderate to severe renal failure at co nception defined by serum creatinine concentration (Scr) ranging from 0.11 to 0.49 mmol/l. All pregnancies took place during the 20-year per iod from 1975 through 1994 and were prospectively followed jointly by our Nephrology Unit and Obstetric and Neonatology Units of University Hospitals. Of the 43 pregnancies (45 fetuses), 13 ended in fetal death (including 5 first-trimester abortions and 8 fetal deaths beyond the 20th gestational week). There were 32 live births, a success rate of 8 2% not considering first-trimester abortions. Successful pregnancies w ere significantly more frequent in the last decade than in the pre ced ing one (91 vs 65%, p = 0.05). Overall live birth rate was higher in p regnancies started with Scr <0.20 mmol/l than in those with Scr >0.20 mmol/l (80% vs 53%, p = 0.02). The upper preconception Scr value assoc iated with a successful fetal outcome was 0.27 mmol/l. Hypertension wa s the major factor of fetal prognosis, as the relative risk of fetal l oss was 10.6 times higher when hypertension was present at conception or early in pregnancy than when blood pressure was spontaneously norma l or well-controlled by therapy. An accelerated course toward end-stag e renal failure was observed in 7 patients (23%), all of whom had seve re hypertension and heavy proteinuria at conception. We conclude that fetal outcome in patients with impaired renal function has been improv ed in recent years, due to advances in obstetrics and neonatology, imp roved blood pressure control and close cooperation between nephrologis ts and obstetricians, but that a risk of fetal loss and of accelerated deterioration of maternal renal disease still persists when Ccr at co nception is lower than 25-30 ml/min/1.73 m(2).