根據即將出版的《美國腎髒病學會雜誌》(JASN)雜誌上的一項研究表明，懷孕期間患有輕度腎髒疾病對母親和嬰兒可能會增加一定的風險。這一發現將有助於指導孕婦產前谘詢和監護。

　　慢性腎髒疾病(CKD)正在呈上升趨勢，研究表明，疾病的早期階段會影響妊娠結果。意大利醫學博士Giorgina Barbara Piccoli和他的同事們領導的研究小組最近進行了一項研究，稱為TOCOS(都靈-卡利亞裏觀察性研究)，將504名有慢性腎髒疾病的孕婦與836名沒有慢性腎髒疾病孕婦的妊娠結局進行比較。

　　研究人員發現，不良妊娠結局的風險，如早產、新生兒重症監護，或母親高血壓的發展，這些風險都在慢性腎髒疾病階段會增加。然而，風險不僅僅是與腎功能下降有關，盡管在第一階段慢性腎髒疾患者腎髒功能在正常範圍內，無症狀表現，但是慢性腎髒疾患者與健康對照組之間相比卻明顯不同。該小組還發現，患者和健康對照組之間胎兒宮內死亡或畸形的風險相比沒有差異。

　　“這一發現表明，任何一種腎髒疾病，甚至是最輕的腎病，如因前期偶發腎感染引起腎瘢痕形成，但腎功能正常，這種情況必須在孕期風險中引起必要的重視，所有的病人都應該需要追蹤觀察以確保安全。”Piccoli博士說。“相反，我們還發現，晚期慢性腎髒疾患者也可能會有好的妊娠結果，她們通常對懷孕不抱什麼希望。”她補充道。

　　研究人員希望新發現有助於建立可以早期診斷和實時觀察慢性腎病孕婦的專門項目。“我們目前在“定級”風險的模型，當患者選擇是否懷孕，醫生可據此來提供信息。“Piccoli博士說。

　　doi:10.1681/ASN.2014050459

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　　Risk of Adverse Pregnancy Outcomes in Women with CKD.

　　Giorgina Barbara Piccoli, Gianfranca Cabiddu, Rossella Attini, Federica Neve Vigotti, Stefania Maxia, Nicola Lepori, Milena Tuveri, Marco Massidda, Cecilia Marchi, Silvia Mura, Alessandra Coscia, Marilisa Biolcati, Pietro Gaglioti, Michele Nichelatti, Luciana Pibiri, Giuseppe Chessa, Antonello Pani, and Tullia Todros.

　　CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (>1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; “general” combined outcome (preterm delivery, NICU, SGA); and “severe” combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4–5: “general” combined outcome, 34.1% versus 90.0%; “severe” combined outcome, 21.4% versus 80.0%; P<0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a “baseline risk” for adverse pregnancy-related outcomes linked to CKD.