Park S, et al. - This study entailed an investigation of the correlation between obstetrical complications and renal prognosis in pregnant women with immunoglobulin A nephropathy (IgAN). It was determined that patients who experienced pregnancies without complications presented with better renal outcomes compared to those without post-biopsy pregnancy. Findings illustrated that the obstetric complications in patients with high renal risk, rather than pregnancy itself, displayed a connection with the renal progression of IgAN women.

Methods

• Experts performed this study by using a propensity-score-matched cohort analysis.
• The inclusion criteria consisted of individuals who experienced pregnancy after their diagnosis among biopsy-confirmed IgAN women in 3 hospitals in Korea.
• Renal outcome comprised of the composite of serum creatinine doubling, estimated glomerular filtration rate (eGFR) halving and events of end-stage renal disease.
• During this study, pregnancies with preterm birth, low birth weight and pre-eclampsia were defined as complicated.

Results

• The enrollment consisted of 59 IgAN women who became pregnant after their diagnosis, and the same number of IgAN women who did not experience pregnancy in the control group.
• Despite pregnancy itself not worsening the renal outcomes [adjusted hazard ratio (HR): 1.51; 95% confidence interval (CI) 0.57-4.01; P=0.41], worse renal prognosis was experienced by mothers with complicated pregnancies, even after adjustment for baseline and pre-gestational characteristics (adjusted HR: 5.07; 95% CI 1.81-14.22; P=0.002).
• It was discovered that this association was only significant in mothers with decreased renal function (eGFR <60 mL/min/1.73 m²) (adjusted HR: 18.70; 95% CI 1.63-214.40; P=0.02), baseline hypertension (adjusted HR: 4.17; 95% CI 1.13-15.33; P=0.03) and overt proteinuria (≥1 g/day) (adjusted HR: 4.21; 95% CI 1.24-14.27; P=0.02).
• On the other hand, better renal outcomes were demonstrated by subjects who experienced pregnancies without complications compared to those without post-biopsy pregnancy (P=0.01).