Maternal Hypertension Disorders and Neonatal Acute Kidney Injury: Results from the AWAKEN Study

Marissa J. DeFreitas; Russell Griffin; Keia Sanderson; Arwa Nada; Jennifer R. Charlton; Jennifer G. Jetton; Alison L. Kent; Ronnie Guillet; David Askenazi; Carolyn L. Abitbol; on behalf of the Neonatal Kidney Collaborative; University of Alabama, Birmingham; Cincinnati Children's Hospital; Canberra Hospital; (currently at the University of Rochester); Children's Hospital of Colorado; (currently Cincinnati Children's Hospital, Cincinnati, OH); Children's Hospital at Montefiore/Albert Einstein; Children's National Medical Center; Golisano Children's Hospital University of Rochester; (currently Union Hospital, Terre Haute); Maimonides Medical Center; McGill University; Medanta, Medicity The Cradle; Metrohealth Medical Center; Nationwide Children's Hospital; Stonybrook University; Texas Children's Hospital; Tufts Medical Center; University of British Columbia; University of Iowa; Patrick Brophy (currently University of Rochester); University of Kentucky; University of Miami; University of Michigan; (currently Medical University of South Carolina); University of New Mexico; (currently Texas Children's Hospital); (currently University of Utah); University of Virginia; (currently University of Wisconsin); University of Washington

doi:10.1055/a-1780-2249

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(05): 649-659
DOI: 10.1055/a-1780-2249

Original Article

Maternal Hypertension Disorders and Neonatal Acute Kidney Injury: Results from the AWAKEN Study

Marissa J. DeFreitas

¹Department of Pediatrics, Division of Pediatric Nephrology, University of Miami/Holtz Children's Hospital, Miami, Florida

,

Russell Griffin

²Department of Epidemiology, University of Alabama Birmingham, Birmingham, Alabama

,

Keia Sanderson

³Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina

,

Arwa Nada

⁴Department of Pediatrics, Division of Nephrology & Hypertension Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, Memphis, Tennessee

,

Jennifer R. Charlton

⁵Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, Virginia

,

Jennifer G. Jetton

⁶Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa

,

Alison L. Kent

⁷Department of Pediatrics, University of Rochester, Rochester, New York

⁸Department of Pediatrics, Australian National University, ACT, Australia

,

Ronnie Guillet

⁷Department of Pediatrics, University of Rochester, Rochester, New York

,

David Askenazi

⁹Department of Pediatrics, Division of Nephrology, University of Alabama Birmingham, Birmingham, Alabama

,

Carolyn L. Abitbol

¹Department of Pediatrics, Division of Pediatric Nephrology, University of Miami/Holtz Children's Hospital, Miami, Florida

,

on behalf of the Neonatal Kidney Collaborative,

University of Alabama, Birmingham

,

Cincinnati Children's Hospital

,

Canberra Hospital

,

(currently at the University of Rochester)

,

Children's Hospital of Colorado

,

(currently Cincinnati Children's Hospital, Cincinnati, OH); Children's Hospital at Montefiore/Albert Einstein

,

Children's National Medical Center

,

Golisano Children's Hospital University of Rochester

,

(currently Union Hospital, Terre Haute)

,

Maimonides Medical Center

,

McGill University

,

Medanta, Medicity The Cradle

,

Metrohealth Medical Center

,

Nationwide Children's Hospital

,

Stonybrook University

,

Texas Children's Hospital

,

Tufts Medical Center

,

University of British Columbia

,

University of Iowa

,

Patrick Brophy (currently University of Rochester); University of Kentucky

,

University of Miami

,

University of Michigan

,

(currently Medical University of South Carolina)

,

University of New Mexico

,

(currently Texas Children's Hospital)

,

(currently University of Utah); University of Virginia

,

(currently University of Wisconsin)

,

University of Washington

› Institutsangaben

Abstract

Objective This study aimed to examine the association between maternal hypertension (HTN) exposure and neonatal acute kidney injury (AKI).

Study Design Retrospective cohort study of 2,162 neonates admitted to 24 neonatal intensive care units (NICUs). Neonates were classified into the following exposure groups: any maternal HTN, chronic maternal HTN, preeclampsia/eclampsia, both, or neither. Demographics, clinical characteristics, and AKI status were compared using Chi-square and analysis of variance. General estimating logistic regression was used to estimate adjusted odds ratios and included a stratified analysis for site of delivery.

Result Neonates exposed to any maternal HTN disorder had a tendency toward less overall and early AKI. When stratified by inborn versus outborn, exposure to both maternal HTN disorders was associated with a significantly reduced odds of early AKI only in the inborn neonates.

Conclusion Exposure to maternal HTN, especially preeclampsia/eclampsia superimposed on chronic HTN, was associated with less likelihood of early AKI in the inborn group.

Key Points

Maternal HTN is associated with less neonatal AKI.
Maternal HTN category is variably associated with AKI.
Inborn status is an important contributor to this association.

Keywords

maternal hypertension - neonatal acute kidney injury - fetal programming - preeclampsia

Volltext

Referenzen

References
1 Booker WA. Hypertensive disorders of pregnancy. Clin Perinatol 2020; 47 (04) 817-833
2 Sutton ALM, Harper LM, Tita ATN. Hypertensive disorders in pregnancy. Obstet Gynecol Clin North Am 2018; 45 (02) 333-347
3 Broekhuijsen K, Ravelli AC, Langenveld J. et al. Maternal and neonatal outcomes of pregnancy in women with chronic hypertension: a retrospective analysis of a national register. Acta Obstet Gynecol Scand 2015; 94 (12) 1337-1345
4 Lai J, Syngelaki A, Nicolaides KH, von Dadelszen P, Magee LA. Impact of new definitions of preeclampsia at term on identification of adverse maternal and perinatal outcomes. Am J Obstet Gynecol 2021; 224 (05) 518.e1-518.e11
5 Gestational Hypertension and Preeclampsia. Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstet Gynecol 2020; 135 (06) e237-e260
6 Brown MA, Magee LA, Kenny LC. et al; International Society for the Study of Hypertension in Pregnancy (ISSHP). The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018; 13: 291-310
7 Moussa HN, Leon MG, Marti A. et al. Pregnancy outcomes in women with preeclampsia superimposed on chronic hypertension with and without severe features. Am J Perinatol 2017; 34 (04) 403-408
8 Davis EF, Lazdam M, Lewandowski AJ. et al. Cardiovascular risk factors in children and young adults born to preeclamptic pregnancies: a systematic review. Pediatrics 2012; 129 (06) e1552-e1561
9 Lazdam M, de la Horra A, Pitcher A. et al. Elevated blood pressure in offspring born premature to hypertensive pregnancy: is endothelial dysfunction the underlying vascular mechanism?. Hypertension 2010; 56 (01) 159-165
10 Leeson CP, Kattenhorn M, Morley R, Lucas A, Deanfield JE. Impact of low birth weight and cardiovascular risk factors on endothelial function in early adult life. Circulation 2001; 103 (09) 1264-1268
11 Hammad IA, Meeks H, Fraser A. et al. Risks of cause-specific mortality in offspring of pregnancies complicated by hypertensive disease of pregnancy. Am J Obstet Gynecol 2020; 222 (01) 75.e1-75.e9
12 Lykke JA, Langhoff-Roos J, Sibai BM, Funai EF, Triche EW, Paidas MJ. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension 2009; 53 (06) 944-951
13 Honigberg MC, Riise HKR, Daltveit AK. et al. Heart failure in women with hypertensive disorders of pregnancy: insights from the cardiovascular disease in norway project. Hypertension 2020; 76 (05) 1506-1513
14 Gemmell L, Martin L, Murphy KE. et al. Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation. J Perinatol 2016; 36 (12) 1067-1072
15 McBride CA, Bernstein IM, Badger GJ, Soll RF. Maternal hypertension and mortality in small for gestational age 22- to 29-week infants. Reprod Sci 2018; 25 (02) 276-280
16 Gagliardi L, Basso O. Maternal hypertension and survival in singletons and twins born at 23-29 weeks: not just one answer…. Pediatr Res 2019; 85 (05) 697-702
17 von Dadelszen P, Magee LA, Taylor EL. et al; Canadian Neonatal Network. Maternal hypertension and neonatal outcome among small for gestational age infants. Obstet Gynecol 2005; 106 (02) 335-339
18 ElSayed E, Daspal S, Yee W. et al; Canadian Neonatal Network Investigators. Outcomes of singleton small for gestational age preterm infants exposed to maternal hypertension: a retrospective cohort study. Pediatr Res 2019; 86 (02) 269-275
19 Yusuf K, Alshaikh B, da Silva O. et al; Canadian Neonatal Network Investigators. Neonatal outcomes of extremely preterm infants exposed to maternal hypertension and cigarette smoking. J Perinatol 2018; 38 (08) 1051-1059
20 Shin SH, Shin SH, Kim SH. et al. The association of pregnancy-induced hypertension with bronchopulmonary dysplasia - a retrospective study based on the Korean Neonatal Network database. Sci Rep 2020; 10 (01) 5600
21 Yu XD, Branch DW, Karumanchi SA, Zhang J. Preeclampsia and retinopathy of prematurity in preterm births. Pediatrics 2012; 130 (01) e101-e107
22 Chen XK, Wen SW, Smith G, Yang Q, Walker M. New-onset hypertension in late pregnancy is associated with lower fetal and infant mortality in preterm twins. Hypertens Pregnancy 2006; 25 (03) 205-215
23 Luo QG, Zhang JY, Cheng WW, Audibert F, Luo ZC. Is gestational hypertension protective against perinatal mortality in twin pregnancies?. PLoS One 2014; 9 (04) e94865
24 Askenazi D, Patil NR, Ambalavanan N. et al. Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants. Pediatr Nephrol 2015; 30 (09) 1511-1518
25 Askenazi DJ, Koralkar R, Hundley HE, Montesanti A, Patil N, Ambalavanan N. Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol 2013; 28 (04) 661-666
26 Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenazi D. Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res 2011; 69 (04) 354-358
27 Lee CC, Chan OW, Lai MY. et al. Incidence and outcomes of acute kidney injury in extremely-low-birth-weight infants. PLoS One 2017; 12 (11) e0187764
28 Weintraub AS, Connors J, Carey A, Blanco V, Green RS. The spectrum of onset of acute kidney injury in premature infants less than 30 weeks gestation. J Perinatol 2016; 36 (06) 474-480
29 Jetton JG, Boohaker LJ, Sethi SK. et al; Neonatal Kidney Collaborative (NKC). Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 2017; 1 (03) 184-194
30 Charlton JR, Boohaker L, Askenazi D. et al; Neonatal Kidney Collaborative. Incidence and risk factors of early onset neonatal AKI. Clin J Am Soc Nephrol 2019; 14 (02) 184-195
31 Charlton JR, Boohaker L, Askenazi D. et al; Neonatal Kidney Collaborative (NKC). Late onset neonatal acute kidney injury: results from the AWAKEN Study. Pediatr Res 2019; 85 (03) 339-348
32 Kirkley MJ, Boohaker L, Griffin R. et al; Neonatal Kidney Collaborative (NKC). Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database. Pediatr Nephrol 2019; 34 (01) 169-176
33 Jetton JG, Guillet R, Askenazi DJ. et al; Neonatal Kidney Collaborative. Assessment of worldwide acute kidney injury epidemiology in neonates: design of a retrospective cohort study. Front Pediatr 2016; 4 (68) 68
34 Lu CQ, Lin J, Yuan L. et al. Pregnancy induced hypertension and outcomes in early and moderate preterm infants. Pregnancy Hypertens 2018; 14: 68-71
35 Chang YS, Liang FW, Lin YJ, Lu TH, Lin CH. Neonatal and infant mortality of very-low-birth-weight infants in Taiwan: does the level of delivery hospital matter?. Pediatr Neonatol 2021; 62 (04) 419-427
36 Palmer KG, Kronsberg SS, Barton BA, Hobbs CA, Hall RW, Anand KJ. Effect of inborn versus outborn delivery on clinical outcomes in ventilated preterm neonates: secondary results from the NEOPAIN trial. J Perinatol 2005; 25 (04) 270-275
37 Ogura S, Suzuki J, Suzuki H. Antihypertensive drug therapy for women with non-severe hypertensive disorders of pregnancy: a systematic review and meta-analysis. Hypertens Res 2019; 42 (05) 699-707
38 Naik Gaunekar N, Raman P, Bain E, Crowther CA. Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour. Cochrane Database Syst Rev 2013; (10) CD004071
39 Regev RH, Arnon S, Litmanovitz I. et al; Israel Neonatal Network. Outcome of singleton preterm small for gestational age infants born to mothers with pregnancy-induced hypertension. A population-based study. J Matern Fetal Neonatal Med 2015; 28 (06) 666-673
40 Perico N, Askenazi D, Cortinovis M, Remuzzi G. Maternal and environmental risk factors for neonatal AKI and its long-term consequences. Nat Rev Nephrol 2018; 14 (11) 688-703
41 Luyckx VA. Preterm birth and its impact on renal health. Semin Nephrol 2017; 37 (04) 311-319
42 Gjerde A, Reisæter AV, Skrunes R, Marti HP, Vikse BE. Intrauterine growth restriction and risk of diverse forms of kidney disease during the first 50 years of life. Clin J Am Soc Nephrol 2020; 15 (10) 1413-1423
43 Abitbol CL, DeFreitas MJ, Strauss J. Assessment of kidney function in preterm infants: lifelong implications. Pediatr Nephrol 2016; 31 (12) 2213-2222
44 Abitbol CL, Rodriguez MM. The long-term renal and cardiovascular consequences of prematurity. Nat Rev Nephrol 2012; 8 (05) 265-274
45 Bokslag A, van Weissenbruch M, Mol BW, de Groot CJ. Preeclampsia; short and long-term consequences for mother and neonate. Early Hum Dev 2016; 102: 47-50
46 Verburg BO, Geelhoed JJ, Steegers EA. et al. Fetal kidney volume and its association with growth and blood flow in fetal life: the Generation R Study. Kidney Int 2007; 72 (06) 754-761
47 Kooijman MN, Bakker H, van der Heijden AJ. et al. Childhood kidney outcomes in relation to fetal blood flow and kidney size. J Am Soc Nephrol 2014; 25 (11) 2616-2624

Zusatzmaterial

Supplementary Material