Addressing Hypertensive Disorders of Pregnancy through a Combined Renal-Maternal Fetal Medicine Clinic

Background: Pregnancy marks a thrilling yet precarious time for women with underlying renal disorders, marked by unique physiologic, immunologic, and hemodynamic changes. These changes, complicated by progression of chronic kidney disease (CKD) and development of hypertensive disorders of pregnancy (HDOP), can endanger mother and fetus if left untreated. Establishing interdisciplinary practices through co-management of CKD and HDOP by nephrologists and maternal fetal medicine (MFM) providers, thus, offers great potential. Through collaborative clinic visits with laboratory and blood pressure monitoring, our study aims to better understand and address gaps in maternal and fetal health outcomes when treating CKD and HDOP. Methods: This retrospective study followed 24 pregnant patients establishing care in our combined Renal-MFM Clinic from September 2022-May 2024. Data encompassed demographics (age, race, zip code, and insurance), obstetric history, estimated gestational age (EGA) at consultation, timing of aspirin initiation, comorbidities, laboratory results, blood pressures, hospitalizations, and delivery outcomes, all cataloged in a Redcap database. Results: Women aged 17-43 years (mean 31.3, median 32) were studied, of whom 54% were White, 29% Black, 8% Hispanic, and 4% Asian. Referrals spanned gestational ages between 9-36 weeks. Around 67% sought care for HDOP, 29% for CKD, 25% for proteinuria, and 13% for nephrolithiasis. Among HDOP cases, 59% had chronic hypertension, 29% chronic hypertension with superimposed pre-eclampsia, and 11% gestational hypertension. Of those with HDOP, 82% were treated with medications, of whom 29% required 2 or more agents to manage blood pressure. Beta-blockers were more frequently selected (used in 57% of patients, alone and in combination with other agents). Prophylactic low-dose aspirin commenced at 13.1 weeks EGA on average. Of the 18 patients who delivered during the study period, 11% had term deliveries, 44% early term, and 44% pre-term delivery, with 2 cases of fetal demise before 20 weeks EGA. Conclusion: This initial study outlines baseline characteristics and outcomes for our combined Renal-MFM clinic. Future directions include evaluating optimal medication management for target blood pressure attainment, expanding patient recruitment statewide, and integrating pre-conception counseling into our combined clinic framework.