Hypertensive disorders in pregnancy

Table 2 Renal disorders and associated maternal and fetal health risks

Maternal and fetal risk by degree of renal impairment
Stage	Pregnancy/fetal outcomes	Renal/maternal outcomes
Early CKD I-II sCr < 1.4 mg/dL eGFR < 70 mL/min Normal BP Minimal proteinuria	Higher risk than general population for preeclampsia, SGA, preterm delivery Counseling: May need specialized care Generally good outcomes	Lower risks for accelerated progression
Moderate CKD II-III sCr 1.4-2.4 mg/dL eGFR 40-70 mL/min	With more advanced CKD and higher proteinuria: Higher risks of caesarian section, preterm delivery, SGA, and need for NICU	Increased risk of progression during pregnancy and within 6 wk postpartum Counseling: Pregnancy termination doesn’t reliably reduce risks for progression
Severe CKD III-IV sCr > 2.4 mg/dL eGFR < 40 mL/min	With more advanced CKD and higher proteinuria: Higher risks of caesarian section, preterm delivery, SGA, and need for NICU care	Increased risk of progression during pregnancy and within 6 wk postpartum
ESRD	Decreased fertility and high fetal mortality except with more intensive hemodialysis Higher risks of preeclampsia, SGA, cervical incompetence, and need for NICU care persist	Increased need for transfusion, worsening hypertension
Post-transplant	± increased risk of fetal loss Increased risk of low birth weight and preterm delivery Significantly increased risk of preeclampsia if hypertensive	Blunted renal physiologic adaptations No anticipated decrease in graft survival but may be associated with decreased maternal life span Increased risk of diabetes, urinary tract infection (due to anatomy, insulin resistance, and immunosuppression)

SGA: Small for gestational age; NICU: Neonatal intensive care unit; CKD: Chronic kidney disease; ESRD: End-stage renal disease.