背景:先天性肾脏和泌尿道异常(CAKUT)是产前诊断的发育畸形的最常见原因。本研究旨在评估母系疾病与子代CAKUT之间的关系。
方法:这项回顾性研究纳入了2020年1月至2022年12月在一家医疗中心登记的所有孕妇。关于孕产妇非传染性疾病的医疗信息,包括肥胖,高血压,糖尿病,肾病,甲状腺功能亢进,甲状腺功能减退,精神疾病,癫痫,癌症,并收集了自身免疫性疾病。根据妊娠晚期的超声扫描记录,诊断分为孤立性尿路扩张(UTD)或肾脏异常.采用多因素logistic回归建立预测产前CAKUT的模型。
结果:在19,656名孕妇中,围产期超声检测到114例(5.8/1000)胎儿可疑CAKUT,包括89例孤立的UTD和25例肾脏异常。在经历过妊娠糖尿病的母亲的胎儿中,产前CAKUT的风险增加,甲状腺功能异常,神经精神疾病,贫血,卵巢和子宫疾病。利用四个混杂因素建立了孤立UTD的预测模型,即妊娠期糖尿病,妊娠期高血压,母体甲状腺功能异常,和肝病。同样,基于四个不同的混杂因素建立了单独的肾脏异常预测模型,即母体甲状腺功能异常,妊娠期糖尿病,卵巢/子宫疾病,和肾脏疾病。
结论:孤立的UTD和肾脏异常与不同的母体疾病有关。结果可能为妊娠的临床管理提供信息,并强调CAKUT各种亚型起源的潜在差异。
BACKGROUND: Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common cause of prenatally diagnosed developmental malformation. This study aimed to assess the relationship between maternal diseases and CAKUT in offspring.
METHODS: This retrospective study enrolled all pregnant women registered from January 2020 to December 2022 at one medical center. Medical information on maternal noncommunicable diseases, including obesity, hypertension, diabetes mellitus, kidney disease, hyperthyroidism, hypothyroidism, psychiatric disease, epilepsy, cancer, and autoimmune disease was collected. Based on the records of ultrasound scanning during the third trimester, the diagnosis was classified as isolated urinary tract dilation (UTD) or kidney anomalies. Multivariate logistic regression was performed to establish models to predict antenatal CAKUT.
RESULTS: Among the 19,656 pregnant women, perinatal ultrasound detected suspicious CAKUT in 114 (5.8/1000) fetuses, comprising 89 cases with isolated UTD and 25 cases with kidney anomalies. The risk of antenatal CAKUT was increased in the fetuses of mothers who experienced gestational diabetes, thyroid dysfunction, neuropsychiatric disease, anemia, ovarian and uterine disorders. A prediction model for isolated UTD was developed utilizing four confounding factors, namely gestational diabetes, gestational hypertension, maternal thyroid dysfunction, and hepatic disease. Similarly, a separate prediction model for kidney anomalies was established based on four distinct confounding factors, namely maternal thyroid dysfunction, gestational diabetes, disorders of ovarian/uterine, and kidney disease.
CONCLUSIONS: Isolated UTD and kidney anomalies were associated with different maternal diseases. The results may inform the clinical management of pregnancy and highlight potential differences in the genesis of various subtypes of CAKUT.