Abstract
RATIONALE & OBJECTIVE: Pregnant women with prepregnancy chronic kidney disease (CKD) are underdiagnosed and experience adverse outcomes. Limited research exists on peripregnancy health care utilization by women with evidence of CKD. STUDY DESIGN: Retrospective cohort analysis. SETTING & PARTICIPANTS: Women with laboratory signs of prepregnancy CKD who had a pregnancy event between January 1, 2016, and March 1, 2023, at Montefiore Health System in Bronx, NY, were included. EXPOSURE & OUTCOMES: We investigated rates of CKD diagnosis, adverse maternal and fetal outcomes, and peripregnancy health care utilization among a sample of women with evidence of prepregnancy 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) postpregnancy CKD prevalence, and (3) peripregnancy health utilization. RESULTS: Of the 247 pregnant women who met criteria for prepregnancy 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 neonatal intensive care unit admission, with worse outcomes seen in those with severe CKD (defined as eGFR < 45 mL/min/1.73 m(2) or proteinuria > 1,000 mg/g). Among women with CKD, 27.6% were seen by primary care within 1 year before 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 at 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.