Pregnancy in late stages of chronic kidney disease in patients with type 1 diabetes mellitus and with chronic glomerulonephritis: comparison of complications and outcomes

Background: in patients with chronic kidney disease (CKD), particularly in advanced stages, pregnancy carries a high risk of complications and adverse outcomes. To date, no direct comparison has been made of pregnancy complications, obstetric, and nephrological outcomes in women with stage 3-5 CKD due to diabetic nephropathy (DN) versus chronic glomerulonephritis (CGN).

Objective: to compare the course of pregnancy, gestational complications, pregnancy outcomes, and postnatal renal survival in women with advanced CKD due to type 1 diabetes mellitus with DN and those with CGN.

Patients and methods: the retrospective study included 53 pregnant women with CKD stage 3-5: 23 women with type 1 diabetes and DN, who had (25 pregnancies; main group), and 30 women with CGN (30 pregnancies; comparison group). Each pregnancy was assessed as a separate clinical case. The groups did not differ in the age, CKD duration, or CKD of stages. Obstetrics complications, perinatal outcomes, and renal survival after delivery were evaluated studied in both groups.

Results: favorable pregnancy outcomes were observed in 92% of pregnancies in the DN group and in 93.3% in the CGN group. Compared with the CGN group, women in the DN group had a significantly higher incidence of pre-existing chronic pyelonephritis (72% vs. 10%, p<0.001), episodes of pyelonephritis during gestation (44.0% vs. 16.7%, p=0.038), the need for multicomponent antihypertensive therapy (84.2% vs. 52.2%, p=0.048), preterm delivery before 37 weeks (79.2% vs. 50%, p=0.046), cesarean section (91.7% vs. 66.7%, p=0.046), and neonatal intensive care admission (70.8% vs. 36.7%, p=0.016). In both groups, preterm birth was significantly associated with gestational hypertension and preeclampsia, but not with proteinuria 3 g/day and above. Renal survival after delivery did not differ between the groups (Log Rank – p = 0.973).

Conclusion: women with type 1 diabetes and CKD stage 3-5 experience higher rates of gestational complications and preterm delivery compared to those with CGN. Preconception counselling and multidisciplinary monitoring are essential to improve both obstetric and nephrological outcomes in this high-risk population.

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