Children with chronic kidney disease (CKD) are highly likely to have an abnormal prenatal history….
Low birth weight, maternal gestational diabetes mellitus, and maternal obesity all affect the risk for childhood CKD.
Christine Hsu, MD, from the University of Washington in Seattle, and colleagues published the results of their population-based case control study. They evaluated 1,994 patients with CKD diagnosed from 1987 to 2008 and 20,032 control patients. The study lacked maternal body mass index data from 44.4% of patients with CKD and 47.7% of control patients.
The investigators identified a prevalence of 126.7 CKD cases per 100,000 births. The adjusted odds ratios were 2.88 for low birth rate (95% confidence interval [CI], 2.28 – 3.63), 1.54 for gestational diabetes mellitus (95% CI, 1.13 – 2.09), 1.24 for maternal overweight (95% CI,1.05 – 1.48), and 1.26 for maternal obesity (95% CI, 1.05 – 1.52). The researchers made adjustments for maternal race, residence of census tract (urban, rural, or missing), and parity.
The authors write, "We have demonstrated significant associations between childhood CKD and primary prenatal exposures of low birth weight and maternal factors, including gestational diabetes mellitus, pregestational diabetes mellitus, overweight and obesity. We identified cases of CKD with structural kidney malformations, one of the criteria for CKD according to both the Kidney Disease Outcomes Quality Initiative and Kidney Disease Improving Global Outcomes. The Washington birth record linkage enabled the largest study to date of these hypotheses."
The current study builds on previous work in the field of CKD epidemiology, which has focused primarily on end-stage renal disease, when dialysis and transplantation become necessary. The results are consistent with previous studies that have suggested that diabetes mellitus may cause abnormal renal development via compromised fetal programming. In addition, maternal obesity has previously been shown to be associated with malformations of the urogenital system.
"Previous data demonstrate that if we educate and provide intensive [diabetes mellitus] care early to diabetic mothers, the rate of congenital malformations in births to diabetic mothers decreases to levels comparable to non-diabetic mothers. Additionally, children with CKD were significantly more likely to have obese mothers; thus our data underscores the potential impact of maternal obesity on future generations," the authors conclude.
J Am Soc Nephrol. Published online April 17, 2014.