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

Thursday, February 13, 2020

4:00 PM – 4:15 PM

Location: Max Bell Auditorium

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.

Presenter(s)

Alexandra F. 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.

Disclosure: Disclosure information not submitted.

First Author(s)

Alexandra F. 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.

Disclosure: Disclosure information not submitted.

Corresponding Author(s)

Alexandra F. 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.

Disclosure: Disclosure information not submitted.

Author(s)

Michelle Hladunewich, MD

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

Disclosure: Disclosure information not submitted.
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

Disclosure: Disclosure information not submitted.
Eden Manly, BSc Candidate

Undergraduate Student
Sunnybrook Health Sciences Centre

Disclosure: Disclosure information not submitted.
Dini Hui, MD

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

Disclosure: Disclosure information not submitted.
Stefania Ronzoni, MD PhD

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

Disclosure: Disclosure information not submitted.
Nir Melamed, MD

MFM Specialist
Sunnybrook Health Sciences Centre, University of Toronto

Disclosure: Disclosure information not submitted.

Submitter(s)

Alexandra F. 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.

Disclosure: Disclosure information not submitted.