Navigating Pregnancy With Primary Glomerular Disease: Experience From a Lower-Middle-Income Country.

Rationale & Objective: Primary glomerular diseases frequently affect women of childbearing age, creating challenges during pregnancy. There is limited data from low and middle-income countries where health care disparities and differing disease patterns may alter outcomes. This study assessed pregnancy and kidney outcomes in women with primary glomerular diseases at a tertiary center in India. Study Design: We conducted a retrospective review of medical records from 2012 to 2022. Setting & Participants: This study was conducted at a single-center and included women aged 18-45 years with biopsy-confirmed primary glomerular disease. In total, 32 women with 44 pregnancies were included. Exposures or Predictors: The exposure of interest was pregnancy following diagnosis of primary glomerular disease, comparing women who achieved live births with a control group who did not conceive after diagnosis of kidney disease. Outcomes: Pregnancy outcomes included preterm delivery, intrauterine growth restriction (IUGR), pre-eclampsia, mode of delivery, and elective and spontaneous abortions. Kidney outcomes included relapse (proteinuria ≥ 3.5 g/day, or ≥ 1 g/day for IgA nephropathy) and kidney disease progression (>40% sustained estimated glomerular filtration rate decline or progression to kidney failure). Analytical Approach: Descriptive analyses were performed, and kidney survival in women with live births was compared to non-pregnant controls using Kaplan-Meier analysis and log-rank testing. Cox regression analysis was used to examine association with kidney disease progression. Results: Of 44 pregnancies, 15 (34.1%) underwent elective and 4 (9.1%) had spontaneous abortions, and (25) 56.8% resulted in live births. The median age at conception was 27.5 years. 10 (40%) live births were preterm and 16 (64%) had IUGR. Pre-eclampsia occurred in 6 (24%) pregnancies. Kidney disease relapsed with 8 (32%) pregnancies. Kidney disease progression occurred in 4 (20%) women with live births, and pregnancy was not associated with disease progression (adjusted hazard ratio: 1.4; 95% CI, 0.2-9.0; Limitations: Retrospective design, small sample size, and single-center data limit interpretation and generalizability. Conclusions: Pregnancy was associated with adverse maternal and fetal outcomes in women with primary glomerular diseases, with significant risk of IUGR, but did not affect the long-term kidney outcome in our patients.