Pregnancy Outcomes in Patients with Primary Glomerular Diseases and the Impact on Kidney Outcomes

Background: Primary glomerular diseases frequently affect women in childbearing age. There is a dearth of information about the impact of pregnancy on the outcome in such diseases. This retrospective cohort study examines pregnancy outcomes in women with biopsy-proven primary glomerular disease and the impact on renal survival. Methods: We assessed the medical records of women in child bearing age (18-45 years) diagnosed with biopsy proven primary glomerular disease (IgAN, FSGS, MGN, MCD) from 2012- 2022 at a single centre AIIMS New Delhi. Patients with end stage kidney disease (ESKD) at the time of biopsy and/or at time of conception and those who had undergone kidney transplantation were excluded. Pregnancy and Kidney outcomes were recorded. Relapse was defined as increase in proteinuria to >3.5g/day (>1g/day for IgAN) and renal disease progression as >40% sustained decline in eGFR and/or ESKD. Results: Of 238 women assessed, 81 were lost to follow up and 125 did not conceive after biopsy. 44 pregnancies were documented in 32 women (IgAN n=21, FSGS n=6, MGN n=10, MCD n=7). The median age of conception was 28.5 (25.2-33.0) years and the median time from biopsy to conception was 3 (2-5.8) years. 15 pregnancies (34%) were medically terminated, 4 (9%) resulted in spontaneous abortions, and 25 (57%) culminated in live births. 12 of 44 (27%) pregnancies occurred while the patient was on ACEi/ARBs of which 7 pregnancies resulted in live births. 12 out of 25 live births were premature and IUGR below 10th percentile affected 15 pregnancies. Preeclampsia affected 6 pregnancies. From a renal perspective, 9 women had active disease at the time of conception. 7 (33%) women had a relapse of kidney disease during pregnancy and 2 (9.5%) women relapsed immediate postpartum. 8 of these 10 women received steroids during pregnancy. In 6 women, there was renal disease progression, of which 1 developed ESKD. Conclusion: Pregnancy is associated with adverse maternal and fetal outcomes in women with primary glomerular diseases.Distribution of pregnancy outcomes