Oral or Poster Presentation

Concurrent Session 2B - Maternal Fetal Medicine

The Predictive Value of Sonographic Placental Markers for Adverse Pregnancy Outcome in Women with Chronic Kidney Disease

Presenter(s)

• Alexandra Moloney, BSc, MD Candidate 2021

  Medical Student
  Division of maternal fetal medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

First Author(s)

• Alexandra Moloney, BSc, MD Candidate 2021

  Medical Student
  Division of maternal fetal medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Corresponding Author(s)

• Alexandra Moloney, BSc, MD Candidate 2021

  Medical Student
  Division of maternal fetal medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Author(s)

• Michelle Hladunewich, MD

  Nephrologist
  Division of Obstetric Medicine, Department of Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

• Jasmine Idris Ali-Gami, BSc Candidate

  Undergraduate Student
  Division of maternal fetal medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

• Eden Manly, BSc Candidate

  Undergraduate Student
  Sunnybrook Health Sciences Centre

• Dini Hui, MD

  MFM Specialist
  Division of maternal fetal medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

• Stefania Ronzoni, MD PhD

  MFM Specialist
  Division of maternal fetal medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

• Nir Melamed, MD

  MFM Specialist
  Sunnybrook Health Sciences Centre, University of Toronto

Submitter(s)

• Alexandra Moloney, BSc, MD Candidate 2021

  Medical Student
  Division of maternal fetal medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Introduction: Pregnant women with chronic kidney disease (CKD) have a very high-risk of placenta-related complications, however data in this group are limited. Our objective was to determine the rate and predictive value of sonographic placental markers for preeclampsia and fetal growth restriction in pregnant women with CKD.

Methods: We completed a retrospective cohort study of singleton pregnancy women with CKD that were followed in the Pregnancy and Kidney Disease Clinic at a tertiary center in Toronto between 2010-2018. All women underwent sonographic placental study between 16-22 weeks that assessed placental dimensions/morphology, cord insertion, and uterine artery Doppler. Continuous placental markers were converted to multiples on medians (MoM) with optimal cutoff values based on ROC curve inflection points. We determined the association and predictive value of sonographic placental markers for preeclampsia and birthweight <10th%.

Results: A total of 86 women with CKD were identified, which as expected had a high rate of preeclampsia (24.4%), preterm birth <37 weeks (30.2%), and birthweight <10th% (26.7%). Risk of preeclampsia was markedly elevated with low placental volume (51.7% vs. 10.9%, p<0.001; OR 8.79, 95%-CI 2.70-28.59 for preeclampsia; and 40.0% vs. 9.1%, p=0.002; OR 6.67, 95%-CI 1.85-24.04 for preterm preeclampsia), and bilateral uterine artery notching (62.5% vs. 20.8%, p=0.009; OR 6.35, 95%-CI 1.37-29.45 for preeclampsia; and 62.5% vs. 10.4%, p<0.001; OR 14.38, 95%-CI 1.29-71.75 for preterm preeclampsia). Low placental volume and bilateral uterine notching were also associated with birthweight<10th%. The combination of low placental volume and bilateral notching had the strongest predictive value for preeclampsia and preterm preeclampsia (positive likelihood ration of 8.25 (95%-CI 6.84-9.95) and 14.31 (95%-CI 10.61-19.30) respectively).

Conclusion: Among pregnant women with CKD, which can be viewed as a group at the highest-risk for placental complications, second trimester sonographic placental study can identify a subgroup of women at even greater risk of preeclampsia and fetal growth restriction.