Health Care Utilization Among Pregnant Women With Pre-existing Kidney Disease: A Retrospective Cohort Analysis.

Rationale & Objective: Pregnant women with prepregnancy chronic kidney disease (CKD) are underdiagnosed and experience adverse outcomes. Limited research exists on peripregnancy health care utilization by women with evidence of CKD. Study Design: Retrospective cohort analysis. Setting & Participants: Women with laboratory signs of prepregnancy CKD who had a pregnancy event between January 1, 2016, and March 1, 2023, at Montefiore Health System in Bronx, NY, were included. Exposure & Outcomes: We investigated rates of CKD diagnosis, adverse maternal and fetal outcomes, and peripregnancy health care utilization among a sample of women with evidence of prepregnancy CKD. Analytical Approach: We tested the proportion of women with laboratory signs of CKD who had a diagnosis code for CKD entered on their problem list. We also examined the association of different eGFR/proteinuria cutoffs among the cohort with (1) adverse pregnancy outcomes, (2) postpregnancy CKD prevalence, and (3) peripregnancy health utilization. Results: Of the 247 pregnant women who met criteria for prepregnancy CKD by estimated glomerular filtration rate (eGFR) or proteinuria, 8.1% had spontaneous abortion, 10.9% had missed abortion, 12.9% had CKD listed in problem list. Out of 80.9% of pregnancy that reached fetal viability, 12.5% had early preterm delivery, 22.6% developed gestational hypertension, and 20.0% of their infants required neonatal intensive care unit admission, with worse outcomes seen in those with severe CKD (defined as eGFR < 45 mL/min/1.73 m Limitations: Retrospective analysis of a single-center data source. Conclusions: Pregnant women with CKD were frequently underdiagnosed and not sufficiently integrated into care before, during, or after pregnancy.