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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 
1   Department of Pediatrics, Division of Pediatric Nephrology, University of Miami/Holtz Children's Hospital, Miami, Florida
,
Russell Griffin
2   Department of Epidemiology, University of Alabama Birmingham, Birmingham, Alabama
,
Keia Sanderson
3   Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina
,
Arwa Nada
4   Department of Pediatrics, Division of Nephrology & Hypertension Le Bonheur Children's Hospital, The University of Tennessee Health Science Center, Memphis, Tennessee
,
Jennifer R. Charlton
5   Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, Virginia
,
Jennifer G. Jetton
6   Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
,
Alison L. Kent
7   Department of Pediatrics, University of Rochester, Rochester, New York
8   Department of Pediatrics, Australian National University, ACT, Australia
,
Ronnie Guillet
7   Department of Pediatrics, University of Rochester, Rochester, New York
,
David Askenazi
9   Department of Pediatrics, Division of Nephrology, University of Alabama Birmingham, Birmingham, Alabama
,
Carolyn L. Abitbol
1   Department 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 Funding Cincinnati Children's Hospital Center for Acute Care Nephrology provided funding to create and maintain the Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings, for the Neonatal Kidney Collaborative steering committee annual meeting at the University of Alabama at Birmingham (UAB), as well as support for some of the AWAKEN investigators at UAB (D.A. David Askenazi, and R.G. Russell Griffin). PICAN is a part of the Department of Pediatrics at UAB, and is funded by Children's of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB's Center for Clinical and Translational Sciences (National Institutes of Health [2] grant UL1TR001417). The AWAKEN study was supported at the University of New Mexico by the Clinical and Translational Science Center (National Institute of Health grant, number: UL1TR001449).
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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

Ethical Approval

Each center received approval from their Human Research Ethics Committee or Institutional Review Board and consent was waived.


Author's Contribution

M.J.D. and C.L.A. designed the study, acquired data, drafted the manuscript, and approved the final version. K.S. and D.A., contributed to the design of the study, edited the manuscript, and approved the final version. R.Gu. acquired data, contributed to the design of the study, edited the manuscript, and approved the final version. R.Gr. contributed to the design of the study, performed the statistical analyses, edited the manuscript, and approved the final version. A.N., J.C., J.G.J., and A.L.K. acquired data, edited the manuscript, and approved the final version.


Supplementary Material



Publikationsverlauf

Eingereicht: 08. November 2021

Angenommen: 08. Februar 2022

Accepted Manuscript online:
23. Februar 2022

Artikel online veröffentlicht:
18. April 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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