Poster Presentation - SOMANZ ASM Society of Obstetric Medicine of Australia and New Zealand ASM 2023

The South Australian maternal kidney disease in pregnancy database - a first look retrospective cohort study of pregnancy in early chronic kidney disease   (#65)

Alessandra Orsillo 1 2 , Jarrad Hopkins 1 2 , Nishanta Tangirala 1 2 3 , Erandi Hewawasam 2 4 , Margaret Arstall 2 , Shilpa Jesudason 1 2
  1. Central and Northern Adelaide Renal and Transplantation Service , Adelaide, SA, Australia
  2. University of Adelaide, Adelaide, South Australia, Australia
  3. Women's and Children's Hospital Foundation, North Adelaide, South Australia
  4. Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia

Introduction:

Pregnancy outcomes in women with early stage chronic kidney disease (CKD) are poorly captured. We aim to advance the data infrastructure available by the establishment of the South Australian pregnancy database, to develop knowledge and care in these medically complex pregnancies. 

Methods:

A database accessible to four major sites with obstetric nephrology care was created on a Redcap platform, to capture all women with CKD who had pregnancy counselling or a pregnancy event. Information collated included the cause and severity of CKD, other pre-existing maternal medical conditions, whether pre-conception counselling was received, as well as maternal and infant complications. Kidney function was followed up at 6 and 12 months post-partum. The first retrospective data collection using this database was conducted within a single centre. Though data from all pregnancies, regardless of duration, was collected, this retrospective study focussed on those >20 weeks gestation. All patients between January 2018 to February 2023 who had chronic kidney disease stage 1-3 prior to pregnancy or in the first term of pregnancy were included. Patients with a renal transplant, CKD 4-5 and who were receiving dialysis prior to pregnancy were excluded.

Results:

Our data captured 38 women with stages 1-3 CKD managed within the obstetric nephrology service. 27 of these women received pre-conception counselling. The majority (28/38) had CKD 1; the remainder evenly split between CKD 2 and 3. There were a total of 47 pregnancy events, all of which led to live births; 44 were singleton and 3 were twin pregnancies. 45 pregnancies had documented delivery dates and of these, 17 (37.8%) were delivered pre-term. Of the premature deliveries, at least 7 had emergency caesarean section, most commonly for obstetric indications. There were 9 episodes of pre-eclampsia. 

Conclusion:

This first retrospective analysis exemplifies the utility of establishing an ongoing database with capture of cases from the major tertiary, obstetric units across South Australia. In the future, additional sites will link into this database as well as our statewide electronic medical record systems, and data will be collected prospectively. Over time, this statewide database will provide valuable insights into chronic kidney disease of all stages in pregnancy.