Presentation Authors: Ericka Sohlberg*, William Brubaker, Chiyuan Amy Zhang, Kai Dallas, Calyani Ganesan, Shen Song, Alan Pao, Joseph Liao, John Leppert, Christopher Elliott, Simon Conti, Stanford, CA
Introduction: Urinary stone disease in pregnancy is thought to increase the risk of preterm delivery, fetal demise and other maternal complications. However, due to low rates of urolithiasis in pregnancy, the majority of epidemiologic studies are limited by small, retrospective reviews. We sought to describe the relationship between urinary stone disease and pregnancy in a large national cohort in order to explore current management patterns and identify the true risk profile of this population.
Methods: We examined the Optum national insurance claims database to identify all pregnant women between 2003-2016 using standardized ICD-9/10, CPT, HCPC and DRG code criteria. We grouped pregnancies by gestational ages and identified all women with an encounter for stone or stone procedure during their pregnancy. We abstracted demographic information as well as codes for pregnancy complications, delivery outcome, maternal comorbidity, stone procedures and imaging. We compared these variables between the pregnant stone-formers and non-stone-formers.
Results: We identified 1.27 million pregnant women during the study period, 11,312 (0.89%) of whom developed urinary stone disease during pregnancy. 18.8% of pregnant women with stones required procedural intervention during their pregnancy and 91.1% underwent imaging. Women with urinary stone disease had a slightly increased risk of fetal demise (13.7% vs 12.5%, p < .001) and preterm delivery (5.8% vs 4.1%, p < .001) compared to pregnant women without stones. Urinary stone disease in pregnancy was similarly associated with increased rates of pre-eclampsia, gestational diabetes, oligohydramnios, pyelonephritis, cystitis and urethritis.
Conclusions: We find a urinary stone incidence of ~9/1000 pregnancies in a large national cohort. Urinary stone disease confers a small increased risk of adverse outcomes in both mother and fetus.