FP045
MATERNAL FOETAL OUTCOMES IN PREGNANT WOMEN WITH POLYCYSTIC KIDNEY DISEASE: HIGH RISK FOR HYPERTENSIVE DISORDERS OF PREGNANCY

INTRODUCTION AND AIMS: Women with autosomal dominant polycystic kidney disease (ADPKD) display a vast array of disease severity in childbearing age, from fully asymptomatic (pregnancy may be the occasion for diagnosis) to different degrees of renal function impairment, hypertension and, more rarely proteinuria. While ADPKD has been considered as a risk factor for cyst complications in pregnancy, less is known on hypertensive disorders and preterm delivery. Our objective was to analyse the main pregnancy-related outcomes in ADPKD patients followed in the Gynaecology and Obstetrics Unit of the Sant’Anna Hospital, Città della Salute e della Scienza, University of Turin (Turin, Italy).

METHODS: Data are prospectively gathered, and compared with patients with other interstitial renal diseases (previous pyelonephritis, reflux nephropathy, single kidney, malformations, recurrent stone disease and nephrocalcinosis) after adjustment for CKD stage, and with a large cohort of low-risk pregnancies followed in the same settings. The considered outcomes were: Ceasarean section, pre-term and early pre-term delivery, small for gestational age baby (SGA) and the development of hypertension, proteinuria and preeclampsia (PE). Data on maternal and foetal death were also gathered, but none of such events occurred.

RESULTS: From January 2000 to June 2017 we followed 24 ADPKD pregnancies. The patients were mainly in early CDK stages (stage 1: 83%) and with no or low-grade proteinuria (<0.5 g/day 92%). Hypertension before pregnancy was present in 25%. To limit heterogeneity, we focused the analysis on CKD stage 1 (20 pregnancies, compared with 856 low-risk pregnancies and 268 pregnancies in patients with other urological diseases). In the 20 ADPKD cases considered, gestational age was 38 weeks (31-41), birth weight 3142 g (1610-4180), two SGA babies (10%) were observed. Four late-preterm and Two early-preterm babies were observed. 5/15 previously normotensive patients developed hypertension during pregnancy and in two cases PE occurred, 3/20 patients displayed proteinuria above 0.5 g/day in pregnancy. Incidence of preterm and early-preterm delivery was significantly higher in ADPKD patients compared with low-risk controls (p: 0.014 and p 0.01 respectively); the incidence of PE was also significantly higher (p: 0.034). ADPKD patients display a significantly higher risk to develop hypertension in pregnancy, as compared with patients with other urological disorders (p: 0.001). Conversely, no significant difference was found in caesarean section, PE and preterm delivery, and separating analysis for periods (2000-2011 vs 2012-2017).

CONCLUSIONS: Pregnancies in women with ADPKD are associated with an increased risk of preterm delivery and hypertensive disorders of pregnancy, even with normal kidney function (CKD stage 1), as compared with low-risk controls; the risk for hypertensive disorders appears specific of ADPKD, as it is significantly higher than what is observed in other urological diseases in the same CKD stage.