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Mother’s health may increase risk for CKD in children

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ASN Renal Week 2010

Children with chronic kidney disease are more likely to have mothers who were obese or had diabetes during pregnancy, according to a study presented at the American Society of Nephrology’s 43^rd Annual Meeting and Scientific Exposition.

The study included more than 4,000 patients with childhood CKD diagnosed at age 21 years or younger. These patients were compared with more than 20,000 healthy children in Washington to evaluate possible relationships between a pregnant woman having diabetes, being obese or overweight, and the risk of her child developing CKD anytime during infancy, childhood or adolescence.

The overall rate of childhood CKD was approximately 0.26% —about one case per 400 live births. When researchers adjusted for length of gestation, CKD risk was 69% higher for children whose mothers had diabetes before pregnancy. For children whose mothers developed gestational diabetes, there was a 28% increase in CKD risk. Children of obese mothers demonstrated a 22% increase in CKD risk.

When specific causes of kidney disease were analyzed, children whose mothers had diabetes before pregnancy had nearly a 700% increase in the risk for kidney-related birth defects, such as renal aplasia/dysplasia.

“Developmental abnormalities of the kidney and urinary tract are the most common cause of childhood CKD,” Christine W. Hsu, MD, of the University of Washington, Seattle, said in a press release.

The risk for obstructive uropathy was increased by 34% for children whose mothers had gestational diabetes, 23% in those whose mothers were obese, and 21% in those whose mothers were overweight but not obese.

“Development of childhood CKD may be programmed prenatally,” Hsu said in the release. Few studies have looked at possible risk factors for CKD development before adulthood.

“Our research shows that childhood CKD is modestly associated with maternal diabetes and maternal overweight or obesity, with the strongest association between abnormal kidney development and maternal diabetes,” Hsu said. “Previous studies have demonstrated that maternal diabetes is associated with an increased risk for general congenital abnormalities. However, with strict control of maternal diabetes, the rate of congenital malformations is similar to that of nondiabetic mothers.”

The data raise the possibility that stricter control of diabetes and weight control during pregnancy may decrease children’s risk for developing CKD.

The researchers noted several study limitations related to using Washington State birth records linked to a hospital discharge database. As a result, it only identified children with CKD who were hospitalized and had kidney disease listed in their hospital discharge diagnoses. The study definition of CKD was also broad, and the results are being reanalyzed with a stricter CKD definition. Finally, conclusions regarding cause and effect are not possible due to the case-control design of the study, the researchers said.

For more information:

• Hsu CW. SA-FC358. Presented at: Renal Week 2010; Nov. 16-21, 2010; Denver.

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