Oral Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Outcomes of patients with pre-pregnancy renal impairment during pregnancy in women with pre-gestational diabetes: A South Western Sydney cohort study (#45)

Andrew Jeyaruban 1 , Renuka Shanmugalingam 1 2 3 4 , Pamela Wu 1 , Rena Cao 1 , Vincent Wong 4 5 , Tang Wong 3 4 6 , Jeff Flack 3 4 6 , Angela Makris 1 2 3 4
  1. Department of Renal Medicine, Liverpool Hospital, SWSLHD, Liverpool, NSW, Australia
  2. Women’s Health Initiative Translational Research Unit (WHITU), Ingham Institute, SWSLHD, Sydney, NSW, Australia
  3. School of Medicine, Western Sydney University, Sydney, NSW, Australia
  4. South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
  5. Department of Endocrinology, Liverpool Hospital SWSLHD, Sydney, NSW
  6. Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, SWSLHD, Sydney, NSW

Background

Pregnant women with pre-pregnancy renal impairment are known to have worse obstetric outcomes with an increased risk of accelerated decline in renal function. This cohort study examines the pregnancy and outcomes of women with pre-gestational diabetes mellitus (PGDM)  with concurrent pre-gestational renal impairment.

 

Method

A retrospective audit of data from pregnant women with PGDM from 2 centres in South-Western Sydney from January 2005 to June 2020 was conducted. Data were obtained from a district wide electronic database and hospital medical records. The outcomes examined were preeclampsia, pre-term delivery (less than 37 weeks) as well as progression to dialysis during and after pregnancy. Women with renal impairment were defined as having a first trimester serum creatinine of greater than 80 µmol/L whilst well.

Results:

In this cohort of 494 women with pre-gestational diabetes, 11(2.5%) women were noted to have serum creatinine of > 80µmol/L in their first antenatal review (1st or 2nd trimester). There were no significant statistical differences in the age, body mass index (BMI), pre-pregnancy HbA1c, and prophylactic aspirin or calcium use between women with and without pre-gestational renal impairment. However, women with renal impairment had a higher rate of previous preeclampsia (32(7.5%) vs 3(27.3%), p=<0.05) compared to women with no renal impairment. There was a significantly higher rate of preeclampsia (36% vs 12%, p<0.05), and preterm delivery ( 60% vs 24.8%, p<0.05) in women with pre-pregnancy renal impairment. Of the 11 women, 1 woman required dialysis during pregnancy and subsequently died 1 month later.

 

Conclusion

Women with pregestational renal impairment were observed to have worse obstetric outcomes. A larger prospective study with significant follow-up would be beneficial in determining the incidence of progression of renal disease in these women in the post-partum period.