Preterm Birth and Other Adverse Pregnancy Outcomes in Women With Chronic Kidney Disease: A Systematic Review with Exploratory Meta-Analyses in Lupus and Diabetic Nephropathy
DOI:
https://doi.org/10.37275/bsm.v10i11.1674Keywords:
Chronic kidney disease, Meta-analysis, Preeclampsia, Pregnancy, Preterm birthAbstract
Background: Chronic kidney disease complicates interpretation of pregnancy risk because exposure definitions, denominators, underlying diseases, and clinical practices vary. This review evaluates associations with preterm birth and other adverse pregnancy outcomes while preserving these distinctions.
Objective: To evaluate associations between pre-existing chronic kidney disease and preterm live birth and other adverse maternal and neonatal outcomes, and to determine which disease-specific estimates could be combined without conflating populations, outcome definitions, or crude and adjusted effects.
Methods: PubMed and Europe PMC were searched with supplementary renal disease and microalbuminuria searches. Comparative observational studies were assessed using a prespecified protocol registered as CRD420261503668. Extraction distinguished established CKD, reduced kidney function, and disease-matched comparisons. Exploratory sensitivity analyses used crude risk ratios, restricted maximum likelihood, and modified Hartung–Knapp intervals.
Results: Thirty-four reports were mapped; eight contributed to three disease-matched crude analyses. The prespecified adjusted primary CKD estimate could not be pooled. Pooled risk ratios were 1.12 (95% confidence interval 0.13–9.35) for lupus-nephritis preterm birth, 2.79 (0.84–9.25) for lupus-nephritis preeclampsia, and 1.35 (1.21–1.51) for diabetic-nephropathy cesarean delivery. Adding a quiescent-nephritis cohort yielded a preterm-birth ratio of 1.24 (0.39–3.97). One cohort contributed 92.1% of the cesarean-analysis weight. Certainty was very low.
Conclusion: Diabetic nephropathy was associated with higher crude cesarean-delivery risk, whereas lupus-nephritis estimates remained highly imprecise. Confounding, repeated pregnancies, and restricted evidence availability limit clinical inference.
Authors
- Evelin Veronike1
- Harnavi Harun1*
- Garri Prima Decroli1
- Muhammad Ridhwan Fatharanifurqan2
- 1Nephrology Division, Department of Uronephrology, Faculty of Medicine, Universitas Andalas/Dr. M. Djamil General Hospital, Padang, Indonesia.
- 2Department of Internal Medicine, Mentawai Islands Regional Hospital, Mentawai, Indonesia.
Corresponding author Harnavi Harun — harnavi@med.unand.ac.id
Article history
- Submitted
- Accepted
- Published
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Evelin Veronike, Harnavi Harun, Garri Prima Decroli, Muhammad Ridhwan Fatharanifurqan
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright and licensing
Copyright in each article remains with the author(s). Authors grant Bioscientia Medicina: Journal of Biomedicine and Translational Research a non-exclusive right of first publication and the right to identify itself as the original publisher. No exclusive transfer of copyright is required.
All articles are published under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0): https://creativecommons.org/licenses/by-nc-sa/4.0/. Users may copy, redistribute, remix, transform, and build upon the material for non-commercial purposes, provided appropriate attribution is given, a link to the license is supplied, changes are indicated, and adaptations are distributed under the same license.
The license applies to the article's scholarly content unless a credit line states otherwise. Third-party material may be subject to separate rights. Authors retain patent, trademark, moral, and research-data rights. The copyright year follows the article's publication date.
