BackgroundChronic kidney disease (CKD) is associated with an increased risk of adverse pregnancy outcomes, but the risk at different stages of CKD (defined by estimated glomerular filtration rate, eGFR) compared with women without CKD has not been quantified in large cohorts.ObjectivesTo quantify the association between CKD and adverse pregnancy outcomes according to CKD definition, CKD stage and presence or absence of diabetes.Search strategyA systematic search of EMBASE and MEDLINE from inception to 5 January 2023.Selection criteriaEnglish‐language randomised controlled trials as well as cohort and case–control studies investigating adverse pregnancy outcomes in pregnant women with CKD.Data collection and analysisTwo reviewers conducted independent data extractions. A random‐effects model was used to estimate risk.Main resultsWe included 19 studies with 3 251 902 women. Defining CKD using eGFR or serum creatinine produced results with greater effect size but wider confidence intervals. Compared with CKD stages 1–2, women with CKD stages 3–5 have a greater risk, but also greater imprecision in the risk estimate, of the following outcomes: pre‐eclampsia (OR 55.18, 95% CI 2.63–1157.68, vs OR 24.74, 95% CI 1.75–348.70), preterm birth (OR 20.24, 95% CI 2.85–143.75, vs OR 8.18, 95% CI 1.54–43.46) and neonatal intensive care unit admission (OR 19.32, 95% CI 3.07–121.68, vs OR 9.77, 95% CI 2.49–38.39). Women with diabetic kidney disease, compared with women without diabetic kidney disease, have higher risks of maternal mortality, small‐for‐gestational‐age neonates, pre‐eclampsia and gestational hypertension.ConclusionsThere is heterogeneity in the definition of CKD in pregnancy. Future studies should consider ways to standardise its definition and measurement in pregnancy.

中文翻译：

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慢性肾病孕妇的不良妊娠结局：系统评价和荟萃分析

背景慢性肾病 (CKD) 与不良妊娠结局的风险增加相关，但与无 CKD 的女性相比，CKD 不同阶段的风险（由估计肾小球滤过率，eGFR 定义）尚未在大型队列中进行量化。根据 CKD 定义、CKD 分期和是否患有糖尿病，了解 CKD 与不良妊娠结局之间的关联。检索策略从 EMBASE 和 MEDLINE 开始到 2023 年 1 月 5 日进行系统检索。选择标准英语随机对照试验以及队列和病例–调查患有 CKD 的孕妇不良妊娠结局的对照研究。数据收集和分析两位评价者进行了独立的数据提取。使用随机效应模型来估计风险。主要结果我们纳入了 19 项研究，涉及 3 251 902 名女性。使用 eGFR 或血清肌酐定义 CKD 产生的结果具有更大的效应量和更宽的置信区间。与 CKD 1-2 期相比，CKD 3-5 期女性出现以下结果的风险更大，但风险估计也更不精确：先兆子痫（OR 55.18，95% CI 2.63-1157.68，vs OR 24.74，95% CI 1.75–348.70)、早产（OR 20.24，95% CI 2.85–143.75，对比 OR 8.18，95% CI 1.54–43.46）和新生儿重症监护室入住（OR 19.32，95% CI 3.07–121.68） ，对比 OR 9.77，95% CI 2.49–38.39）。与无糖尿病肾病的女性相比，患有糖尿病肾病的女性发生孕产妇死亡、小于胎龄儿、先兆子痫和妊娠期高血压的风险更高。结论妊娠期 CKD 的定义存在异质性。未来的研究应该考虑如何标准化妊娠期的定义和测量。