Maternal and fetal risk factors for congenital anomalies of the kidney and urinary tract: a birth cohort study in urban China

Wei Zhang; Xiaochun Zhou; Weikai Wang; Li Wang; Chuan Zhang; Jianqin Wang

doi:10.1007/s40620-024-02066-8

Maternal and fetal risk factors for congenital anomalies of the kidney and urinary tract: a birth cohort study in urban China

J Nephrol. 2024 Sep 20. doi: 10.1007/s40620-024-02066-8. Online ahead of print.

Authors

Wei Zhang^{1

2}, Xiaochun Zhou¹, Weikai Wang², Li Wang², Chuan Zhang³, Jianqin Wang⁴

Affiliations

¹ Department of Nephrology, Gansu Provincial Clinical Medical Research Center for Renal Diseases, The Second Hospital and Clinical Medical School, Lan Zhou University, No. 82, Cui Yingmen, Linxia Road, Chengguan District, Lanzhou, Gansu Province, China.
² Department of Pediatric Comprehensive Medicine, Gansu Provincial Maternity and Child Care Hospital, 143 North Road Qilihe District, Lanzhou, 730050, Gansu Province, China.
³ Gansu Province Medical Genetics Center, Gansu Provincial Maternity and Childcare Hospital, 143 North Road Qilihe District, Lanzhou, Gansu Province, China.
⁴ Department of Nephrology, Gansu Provincial Clinical Medical Research Center for Renal Diseases, The Second Hospital and Clinical Medical School, Lan Zhou University, No. 82, Cui Yingmen, Linxia Road, Chengguan District, Lanzhou, Gansu Province, China. 756751417@qq.com.

PMID: 39302621
DOI: 10.1007/s40620-024-02066-8

Abstract

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are among the most common causes of kidney diseases in children. Previous studies on CAKUT etiologies have been predominantly focused on non-modifiable genetic risk factors. The existing nongenetic studies are limited by lack of comprehensive investigation of potentially modifiable risk factors and the inability to distinguish among various phenotypes of CAKUT. Therefore, this study aimed to comprehensively evaluate both maternal and fetal risk factors of CAKUT, sorted by disease phenotype.

Methods: A prospective birth cohort study was conducted among 10,179 women who delivered a singleton live newborn in Lanzhou, China, between 2010 and 2012. Face-to-face interviews were conducted among the participants within 1-3 days after delivery using standard questionnaires to collect information on maternal demographics and characteristics. All newborns underwent postnatal renal ultrasonographic screening during their routine 1-month checkup. Clinical data, including birth outcomes and maternal complications, were confirmed by reviewing their medical records. Maternal and fetal risk factors were compared in children with and without CAKUT. Multivariable logistic regression analysis was performed to identify independent risk factors of CAKUT and their phenotypes, respectively.

Results: A total of 489 (4.8%) cases of CAKUT were identified. Logistic regression revealed that maternal overweight (pre-pregnancy), gestational diabetes, preterm birth, and low birth weight were independent risk factors for CAKUT. Maternal overweight increased the risk of vesicoureteral reflux (VUR, odds ratio (OR) = 1.441, 95% confidence interval (CI) 1.010-2.057) and posterior urethral valves (PUV, OR = 1.868, 95% CI 1.074-3.249). Gestational diabetes increased the risk of ureteropelvic junction obstruction (UPJO, OR = 1.269; 95% CI 1.044-1.543) and posterior urethral valves (OR = 1.794; 95% CI 1.302-2.474). Preterm birth increased the risk of ureteropelvic junction obstruction (OR = 1.056; 95% CI 1.004-1.111).

Conclusions: Our study identified various risk factors associated with different CAKUT phenotypes, stressing the importance of separate analyses for each phenotype. Our findings may provide helpful guidance on developing targeted and effective CAKUT prevention programs in the future.

Keywords: Congenital anomalies of the kidney and urinary tract (CAKUT); Gestational diabetes; Low birth weight; Overweight; Preterm birth; Risk factors.

Abstract

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