Stillbirth tied to higher risk for long term maternal renal disease

  • Barrett PM & al.
  • Am J Obstet Gynecol
  • 26 Feb 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Women with a history of stillbirth were at an increased risk for chronic kidney disease (CKD) and end-stage renal disease (ESRD) compared with women who have only had live births.
  • This association was independent of pre-eclampsia, small for gestational age (SGA), maternal smoking, obesity, and medical comorbidities.

Why this matters

  • Findings suggest that women who experience stillbirth may warrant closer surveillance for postpartum hypertension and CKD.

Study design

  • A population-based cohort study of 1,941,057 unique women who had 3,755,444 singleton pregnancies and followed up over 42,313,758 person-years.
  • Funding: The Wellcome Trust and the Health Research Board and others.

Key results

  • 13,032 (0.7%) women had ≥1 stillbirth, of which 11,841 (91%) were antepartum.
  • Women who had experienced ≥1 stillbirth were at a higher risk of developing CKD (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.09-1.45) and ESRD (aHR, 2.25; 95% CI, 1.55-3.25) compared with women who only had live births.
  • The association between stillbirth and CKD was largely driven by antepartum stillbirths vs no stillbirth (aHR, 2.27; 95% CI, 1.54-3.35).
  • The associations of stillbirth with CKD (aHR, 1.33; 95% CI, 1.13-1.57) and ESRD (aHR, 2.95; 95% CI, 1.86-4.68) were independent of pre-eclampsia, SGA or congenital malformations.
  • No significant association observed between stillbirth and either CKD (aHR, 1.13; 95% CI, 0.73-1.75) or ESRD (aHR, 1.49; 95% CI, 0.78-2.85) in women who had pre-existing medical comorbidities.

Limitations

  • Study did not conduct an analysis of recurrent stillbirth because of small numbers and paucity of the outcomes.