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Health Care Utilization Among Pregnant Women With Pre-existing Kidney Disease: A Retrospective Cohort Analysis

Year: 2025

Type: article

Abstract: Rationale & Objective Pregnant women with pre-pregnancy chronic kidney disease (CKD) are under diagnosed and experience adverse outcomes. Limited research exists on peri-pregnancy health care utilization by women with evidence of CKD. Study Design Retrospective cohort analysis Setting & Participants Women with laboratory signs of pre-pregnancy CKD who had a pregnancy event between January 1, 2016 and March 1, 2023 at Montefiore Health System (MHS) in Bronx, NY were included. Exposure and outcomes We investigated rates of CKD diagnosis, adverse maternal and fetal outcomes and peri-pregnancy health care utilization among a sample of women with evidence of pre-pregnancy CKD. Analytical Approach We tested the proportion of women with laboratory signs of CKD who had a diagnosis code for CKD entered on their problem list. We also examined the association of different eGFR/proteinuria cutoffs among the cohort with 1-adverse pregnancy outcomes, 2-post-pregnancy CKD prevalence and 3-peri-pregnancy health utilization. Results Of the 247 pregnant women who met criteria for pre-pregnancy CKD by estimated glomerular filtration rate (eGFR) or proteinuria, 8.1% had spontaneous abortion, 10.9% had missed abortion, 12.9% had CKD listed in problem list. Out of 80.9% of pregnancy that reached fetal viability, 12.5% had early preterm delivery, 22.6% developed gestational hypertension and 20.0% of their infants required NICU admission, with worse outcomes seen in those with severe CKD (defined as eGFR<45 ml/min/1.73m 2 ; or proteinuria >1000 mg/g). Among women with CKD, 27.6% were seen by primary care within 1 year prior to pregnancy while less than 0.1% were ever seen by a nephrologist. Among women with severe CKD, only 40% were seen by nephrology during pregnancy and less than 50% had a nephrology appointment arranged upon discharge. Limitations Retrospective analysis of a single-center data source. Conclusions Pregnant women with CKD were frequently underdiagnosed and not sufficiently integrated into care before, during, or after pregnancy.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2025.101147