慢性肾脏病母亲的新生儿结局

许照洁; 罗芳

doi:10.7499/j.issn.1008-8830.2207017

PDF(524 KB)

HTML

中国当代儿科杂志 ›› 2023, Vol. 25 ›› Issue (1) : 104-108. DOI: 10.7499/j.issn.1008-8830.2207017

综述

慢性肾脏病母亲的新生儿结局

许照洁, 罗芳

作者信息 +

Outcome of neonates born to mothers with chronic kidney disease

XU Zhao-Jie, LUO Fang

Author information +

文章历史 +

摘要

约3%的孕妇患有慢性肾脏病（chronic kidney disease，CKD）。该文复习了关于CKD母亲（包括透析和肾移植患者）的新生儿结局的文献。文献显示：妊娠合并CKD会增加新生儿发生早产、低出生体重及小于胎龄儿的风险，但不增加发生先天结构畸形的风险；从远期结局来看，对子代体格发育、免疫功能无显著影响；子代的神经发育结局与早产、低出生体重相关，与宫内药物暴露无关。仍需更进一步的研究及随访以探讨CKD母亲的新生儿结局。

Abstract

About 3% of pregnant women suffer from chronic kidney disease (CKD). This article reviews the literature on the outcomes of neonates born to mothers with CKD (including those undergoing dialysis and kidney transplantation), and the results show that CKD during pregnancy may increase the risk of preterm birth, low birth weight, and small for gestational age infant, but it does not increase the risk of congenital anomalies. As for long-term outcomes, CKD during pregnancy has no significant impact on offspring's physical development and immune function. Neurodevelopmental outcome of offspring is associated with preterm birth and low birth weight, rather than intrauterine drug exposure. However, further research and follow-up are needed to investigate the outcome of neonates born to mothers with CKD.

导出引用

许照洁, 罗芳. 慢性肾脏病母亲的新生儿结局[J]. 中国当代儿科杂志. 2023, 25(1): 104-108 https://doi.org/10.7499/j.issn.1008-8830.2207017

XU Zhao-Jie, LUO Fang. Outcome of neonates born to mothers with chronic kidney disease[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(1): 104-108 https://doi.org/10.7499/j.issn.1008-8830.2207017

参考文献

1 Piccoli GB, Zakharova E, Attini R, et al. Pregnancy in chronic kidney disease: need for higher awareness. A pragmatic review focused on what could be improved in the different CKD stages and phases[J]. J Clin Med, 2018, 7(11): 415. PMID: 30400594. PMCID: PMC6262338. DOI: 10.3390/jcm7110415.
2 Lameire NH, Levin A, Kellum JA, et al. Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference[J]. Kidney Int, 2021, 100(3): 516-526. PMID: 34252450. DOI: 10.1016/j.kint.2021.06.028.
3 Al Khalaf SY, O'Reilly éJ, McCarthy FP, et al. Pregnancy outcomes in women with chronic kidney disease and chronic hypertension: a national cohort study[J]. Am J Obstet Gynecol, 2021, 225(3): 298.e1-298.e20. PMID: 33823152. DOI: 10.1016/j.ajog.2021.03.045.
4 Haseler E, Melhem N, Sinha MD. Renal disease in pregnancy: fetal, neonatal and long-term outcomes[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 57: 60-76. PMID: 30930143. DOI: 10.1016/j.bpobgyn.2019.01.018.
5 黄雯. 妊娠对肾脏的影响及慢性肾脏病患者的妊娠问题[J]. 中华肾病研究电子杂志, 2018, 7(6): 245-249. DOI: 10.3877/cma.j.issn.2095-3216.2018.06.002.
6 Sarwar A. Drugs in renal disease and pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 57: 106-119. PMID: 31031053. DOI: 10.1016/j.bpobgyn.2019.03.006.
7 G?testam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation[J]. Ann Rheum Dis, 2016, 75(5): 795-810. PMID: 26888948. DOI: 10.1136/annrheumdis-2015-208840.
8 de Vetten L, van Stuijvenberg M, Kema IP, et al. Maternal use of prednisolone is unlikely to be associated with neonatal adrenal suppression: a single-center study of 16 cases[J]. Eur J Pediatr, 2017, 176(8): 1131-1136. PMID: 28695270. PMCID: PMC5511318. DOI: 10.1007/s00431-017-2949-1.
9 Belizna C, Meroni PL, Shoenfeld Y, et al. In utero exposure to Azathioprine in autoimmune disease. Where do we stand?[J]. Autoimmun Rev, 2020, 19(9): 102525. PMID: 32240856. DOI: 10.1016/j.autrev.2020.102525.
10 Ebrahimi-Fakhari D, Stires G, Hahn E, et al. Prenatal sirolimus treatment for rhabdomyomas in tuberous sclerosis[J]. Pediatr Neurol, 2021, 125: 26-31. PMID: 34624607. DOI: 10.1016/j.pediatrneurol.2021.09.014.
11 Cavalheiro S, da Costa MDS, Richtmann R. Everolimus as a possible prenatal treatment of in utero diagnosed subependymal lesions in tuberous sclerosis complex: a case report[J]. Childs Nerv Syst, 2021, 37(12): 3897-3899. PMID: 34008055. DOI: 10.1007/s00381-021-05218-4.
12 Colla L, Diena D, Rossetti M, et al. Immunosuppression in pregnant women with renal disease: review of the latest evidence in the biologics era[J]. J Nephrol, 2018, 31(3): 361-383. PMID: 29476421. DOI: 10.1007/s40620-018-0477-3.
13 Sarno L, Tufano A, Maruotti GM, et al. Eculizumab in pregnancy: a narrative overview[J]. J Nephrol, 2019, 32(1): 17-25. PMID: 30159857. DOI: 10.1007/s40620-018-0517-z.
14 Ashworth D, Battersby C, Green M, et al. Which antihypertensive treatment is better for mild to moderate hypertension in pregnancy?[J]. BMJ, 2022, 376: e066333. PMID: 35042721. DOI: 10.1136/bmj-2021-066333.
15 Gouveia IF, Silva JR, Santos C, et al. Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease[J]. J Bras Nefrol, 2021, 43(1): 88-102. PMID: 33460427. PMCID: PMC8061969. DOI: 10.1590/2175-8239-JBN-2020-0055.
16 Fu J, Tomlinson G, Feig DS. Increased risk of major congenital malformations in early pregnancy use of angiotensin-converting-enzyme inhibitors and angiotensin-receptor-blockers: a meta-analysis[J]. Diabetes Metab Res Rev, 2021, 37(8): e3453. PMID: 33779043. DOI: 10.1002/dmrr.3453.
17 Wang M, Chen S, He Y, et al. Low-dose aspirin for the prevention of severe preeclampsia in patients with chronic kidney disease: a retrospective study : this is the study for kidney and pregnancy[J]. J Nephrol, 2021, 34(5): 1631-1639. PMID: 33914255. DOI: 10.1007/s40620-021-01049-3.
18 Dvo?ák J, Koucky M, Jan?ová E, et al. Chronic kidney disease and pregnancy outcomes[J]. Sci Rep, 2021, 11(1): 21299. PMID: 34716386. PMCID: PMC8556278. DOI: 10.1038/s41598-021-00670-3.
19 He Y, Li Z, Chen S, et al. Pregnancy in patients with stage 3-5 CKD: maternal and fetal outcomes[J]. Pregnancy Hypertens, 2022, 29: 86-91. PMID: 35803200. DOI: 10.1016/j.preghy.2022.06.005.
20 Piccoli GB, Cabiddu G, Attini R, et al. Outcomes of pregnancies after kidney transplantation: lessons learned from CKD. A comparison of transplanted, nontransplanted chronic kidney disease patients and low-risk pregnancies: a multicenter nationwide analysis[J]. Transplantation, 2017, 101(10): 2536-2544. PMID: 28114169. DOI: 10.1097/TP.0000000000001645.
21 Hewawasam E, Davies CE, Li Z, et al. Determinants of perinatal outcomes in dialyzed and transplanted women in Australia[J]. Kidney Int Rep, 2022, 7(6): 1318-1331. PMID: 35685315. PMCID: PMC9171625. DOI: 10.1016/j.ekir.2022.03.015.
22 Piccoli GB, Minelli F, Versino E, et al. Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes[J]. Nephrol Dial Transplant, 2016, 31(11): 1915-1934. PMID: 26614270. DOI: 10.1093/ndt/gfv395.
23 Shah S, Christianson AL, Meganathan K, et al. Racial differences and factors associated with pregnancy in ESKD patients on dialysis in the United States[J]. J Am Soc Nephrol, 2019, 30(12): 2437-2448. PMID: 31554657. PMCID: PMC6900804. DOI: 10.1681/ASN.2019030234.
24 Wiles K, de Oliveira L. Dialysis in pregnancy[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 57: 33-46. PMID: 30606688. DOI: 10.1016/j.bpobgyn.2018.11.007.
25 Hladunewich MA, Hou S, Odutayo A, et al. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison[J]. J Am Soc Nephrol, 2014, 25(5): 1103-1109. PMID: 24525032. PMCID: PMC4005313. DOI: 10.1681/ASN.2013080825.
26 Luders C, Titan SM, Kahhale S, et al. Risk factors for adverse fetal outcome in hemodialysis pregnant women[J]. Kidney Int Rep, 2018, 3(5): 1077-1088. PMID: 30197974. PMCID: PMC6127404. DOI: 10.1016/j.ekir.2018.04.013.
27 Shah S, Venkatesan RL, Gupta A, et al. Pregnancy outcomes in women with kidney transplant: meta analysis and systematic review[J]. BMC Nephrol, 2019, 20(1): 24. PMID: 30674290. PMCID: PMC6345071. DOI: 10.1186/s12882-019-1213-5.
28 Chewcharat A, Kattah AG, Thongprayoon C, et al. Comparison of hospitalization outcomes for delivery and resource utilization between pregnant women with kidney transplants and chronic kidney disease in the United States[J]. Nephrology (Carlton), 2021, 26(11): 879-889. PMID: 34240784. DOI: 10.1111/nep.13938.
29 Ponticelli C, Zaina B, Moroni G. Planned pregnancy in kidney transplantation. A calculated risk[J]. J Pers Med, 2021,11(10): 956. PMID:34683097. PMCID:PMC8537874. DOI: 10.3390/jpm11100956.
30 Dinelli MIS, Ono E, Viana PO, et al. Growth of children born to renal transplanted women[J]. Eur J Pediatr, 2017, 176(9): 1201-1207. PMID: 28721465. DOI: 10.1007/s00431-017-2965-1.
31 Bachmann F, Budde K, Gerland M, et al. Pregnancy following kidney transplantation: impact on mother and graft function and focus on childrens' longitudinal development[J]. BMC Pregnancy Childbirth, 2019, 19(1): 376. PMID: 31646983. PMCID: PMC6813087. DOI: 10.1186/s12884-019-2496-z.
32 Ono E, Dos Santos AM, Viana PO, et al. Immunophenotypic profile and increased risk of hospital admission for infection in infants born to female kidney transplant recipients[J]. Am J Transplant, 2015, 15(6): 1654-1665. PMID: 25833197. DOI: 10.1111/ajt.13143.
33 Schreiber-Zamora J, Szpotanska-Sikorska M, Drozdowska-Szymczak A, et al. Neurological development of children born to mothers after kidney transplantation[J]. J Matern Fetal Neonatal Med, 2019, 32(9): 1523-1527. PMID: 29157047. DOI: 10.1080/14767058.2017.1407754.
34 Nulman I, Sgro M, Barrera M, et al. Long-term neurodevelopment of children exposed in utero to ciclosporin after maternal renal transplant[J]. Paediatr Drugs, 2010, 12(2): 113-122. PMID: 20095652. DOI: 10.2165/11316280-000000000-00000.
35 Eves R, Mendon?a M, Baumann N, et al. Association of very preterm birth or very low birth weight with intelligence in adulthood: an individual participant data meta-analysis[J]. JAMA Pediatr, 2021, 175(8): e211058. PMID: 34047752. PMCID: PMC8329745. DOI: 10.1001/jamapediatrics.2021.1058.
36 Yoneda N, Yoneda S, Tsuda S, et al. Pre-eclampsia complicated with maternal renal dysfunction is associated with poor neurological development at 3 years old in children born before 34 weeks of gestation[J]. Front Pediatr, 2021, 9: 624323. PMID: 33996679. PMCID: PMC8116540. DOI: 10.3389/fped.2021.624323.