根据即将出版的《美国肾脏病学会杂志》(JASN)杂志上的一项研究表明，怀孕期间患有轻度肾脏疾病对母亲和婴儿可能会增加一定的风险。这一发现将有助于指导孕妇产前咨询和监护。

　　慢性肾脏疾病(CKD)正在呈上升趋势，研究表明，疾病的早期阶段会影响妊娠结果。意大利医学博士Giorgina Barbara Piccoli和他的同事们领导的研究小组最近进行了一项研究，称为TOCOS(都灵-卡利亚里观察性研究)，将504名有慢性肾脏疾病的孕妇与836名没有慢性肾脏疾病孕妇的妊娠结局进行比较。

　　研究人员发现，不良妊娠结局的风险，如早产、新生儿重症监护，或母亲高血压的发展，这些风险都在慢性肾脏疾病阶段会增加。然而，风险不仅仅是与肾功能下降有关，尽管在第一阶段慢性肾脏疾患者肾脏功能在正常范围内，无症状表现，但是慢性肾脏疾患者与健康对照组之间相比却明显不同。该小组还发现，患者和健康对照组之间胎儿宫内死亡或畸形的风险相比没有差异。

　　“这一发现表明，任何一种肾脏疾病，甚至是最轻的肾病，如因前期偶发肾感染引起肾瘢痕形成，但肾功能正常，这种情况必须在孕期风险中引起必要的重视，所有的病人都应该需要追踪观察以确保安全。”Piccoli博士说。“相反，我们还发现，晚期慢性肾脏疾患者也可能会有好的妊娠结果，她们通常对怀孕不抱什么希望。”她补充道。

　　研究人员希望新发现有助于建立可以早期诊断和实时观察慢性肾病孕妇的专门项目。“我们目前在“定级”风险的模型，当患者选择是否怀孕，医生可据此来提供信息。“Piccoli博士说。

　　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.