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. Data from low- and middle-income countries are limited, where healthcare 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. Exposure(s) or Predictor(s) 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. Outcome(s) Pregnancy outcomes included preterm delivery, intrauterine growth restriction (IUGR), pre-eclampsia, mode of delivery, 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 eGFR 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 and log-rank testing. Cox regression analysis was used to examine association with kidney disease progression Results Of 44 pregnancies, 15(34.1)% had elective and 4(9.1%) spontaneous abortions, and (25) 56.8% resulted in live births. 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 was not associated with disease progression(aHR: 1.4, 95% CI: 0.2-9.0, P=0.71). 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.