Women with Alport and Mild Kidney Disease Can Have Normal Pregnancies, Study Suggests

Women with Alport syndrome and mild chronic kidney disease (CDK) may have normal pregnancies, according to a study, but more research is necessary to confirm this finding.

The study, “Pregnancy Outcomes In Patients With Alport Syndrome,” was published in the journal Archives of Gynecology and Obstetrics.

Most Alport studies include men, so little is known about pregnancy outcomes in women with the disease.

Researchers decided to investigate Alport’s impact on pregnancy, and whether pregnancy impacts Alport. They tracked eight pregnancies of three family members with mutations of the COL4A3 gene, which causes the rarest form of Alport. Then they compared the outcomes of the pregnancies with 10 previously reported outcomes in women with different Alport mutations.

Thirteen of the 18 pregnancies analyzed, 72 percent, were not associated with permanent worsening of the mother’s kidney function. These mothers had mild, or stage G1, CKD before becoming pregnant and experienced only a temporary increase in proteinuria — proteins in the urine that are a manifestation of Alport.

One woman had a temporary decrease in estimated glomerular filtration rate, an assessment of kidney function.

In four cases, or 22 percent, mothers’ kidney function worsened after pregnancy. Their condition was further complicated with pre-eclampsia, or high blood pressure and excessive protein in the urine.

One of the four had CKD stage G2A3 and chronic hypertension, or high blood pressure. Two had CKD stage G1A3, with one of the two displaying pre-pregnancy proteinuria close to values associated with kidney disease. The fourth mother reported kidney function loss, but no information about her pre-pregnancy status was available.

One mother reported CKD stage G2 after pregnancy, but no information about her pre-pregnancy status was available, either.

The analysis indicated that the level of proteinuria near delivery was not associated with permanent worsening of kidney function.

As for pregnancy outcomes, 11 babies, or 61 percent, were premature, and seven, or 39 percent,  were delivered by cesarean section — but not due to fetal distress. Two stillbirths occurred, one associated with the mother’s poor health condition. All the babies who survived had good health after delivery.

Five pregnancies were complicated with pre-eclampsia.

“[A]lthough the information regarding pregnancies with Alport syndrome is limited and should benefit from further research, the available data suggest that the prognosis of young patients with CKD stage G1 without hypertension or proteinuria within the [acceptable] range before pregnancy is good,” researchers concluded. “However, the physician should inform the patient about the risk for preterm delivery and cesarean section as well as the risk for [kidney] deterioration, particularly if the pregnancy is complicated with preeclampsia.”