Chronic kidney disease and adverse pregnancy outcomes: a systematic review and meta-analysis

dc.check.date2022-11-02
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisher.en
dc.contributor.authorAl Khalaf, Sukainah
dc.contributor.authorBodunde, Elizabeth
dc.contributor.authorMaher, Gillian M.
dc.contributor.authorO'Reilly, Éilis J.
dc.contributor.authorMcCarthy, Fergus P.
dc.contributor.authorO'Shaughnessy, Michelle M.
dc.contributor.authorO'Neill, Sinéad M.
dc.contributor.authorKhashan, Ali S.
dc.contributor.funderMinistry of Education, Saudi Arabiaen
dc.date.accessioned2022-04-22T14:42:08Z
dc.date.available2022-04-22T14:42:08Z
dc.date.issued2021-11-02
dc.date.updated2022-04-22T14:29:21Z
dc.description.abstractObjective: 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.en
dc.description.sponsorshipMinistry of Education, Saudi Arabia (PhD scholarship reference number KSP12021033)en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationAl Khalaf, S., Bodunde, E., Maher, G. M., O'Reilly, É. J., McCarthy, F. P., O'Shaughnessy, M. M., O'Neill, S. M. and Khashan, A. S. (2021) 'Chronic kidney disease and adverse pregnancy outcomes: a systematic review and meta-analysis', American Journal of Obstetrics and Gynecology. doi: 10.1016/j.ajog.2021.10.037en
dc.identifier.doi10.1016/j.ajog.2021.10.037en
dc.identifier.issn0002-9378
dc.identifier.journaltitleAmerican Journal of Obstetrics and Gynecologyen
dc.identifier.urihttps://hdl.handle.net/10468/13111
dc.language.isoenen
dc.publisherElsevier Inc.en
dc.rights© 2021, Elsevier Inc. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license.en
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectChronic kidney diseaseen
dc.subjectFetal outcomeen
dc.subjectPerinatal outcomeen
dc.subjectPreeclampsia pregnancyen
dc.subjectPregnancy outcomeen
dc.titleChronic kidney disease and adverse pregnancy outcomes: a systematic review and meta-analysisen
dc.typeArticle (peer-reviewed)en
Files
Original bundle
Now showing 1 - 4 of 4
Loading...
Thumbnail Image
Name:
CORA_CKD_manuscript.pdf
Size:
552.04 KB
Format:
Adobe Portable Document Format
Description:
Accepted Version
Loading...
Thumbnail Image
Name:
ScienceDirect_files_22Apr2022_14-49-22.195.zip
Size:
126.58 MB
Format:
http://www.iana.org/assignments/media-types/application/zip
Description:
Supplementary Files
Loading...
Thumbnail Image
Name:
CORA_supplementary_CKD_meta-analysis.docx
Size:
600.32 KB
Format:
Microsoft Word XML
Description:
Supplementary Material
Loading...
Thumbnail Image
Name:
CORA_CKD_manuscript.docx
Size:
353.28 KB
Format:
Microsoft Word XML
Description:
Author's Original Accepted Version
License bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
license.txt
Size:
2.71 KB
Format:
Item-specific license agreed upon to submission
Description: