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Elevated levels of renal function tests conferred increased risks of developing various pregnancy complications and adverse perinatal outcomes: insights from a population-based cohort study

  • Zhengwen Xu , He S. Yang , Lin Liu , Lanlan Meng , Yifan Lu , Lican Han , Guodong Tang , Jing Wang , Lu Chen , Yue Zhang , Yanhong Zhai EMAIL logo , Shaofei Su EMAIL logo and Zheng Cao ORCID logo EMAIL logo
Published/Copyright: April 6, 2023
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 61 Issue 10

Abstract

Objectives

Physiological changes during pregnancy can affect the results of renal function tests (RFTs). In this population-based cohort study, we aimed to establish trimester-specific reference intervals (RIs) of RFTs in singleton and twin pregnancies and systematically investigate the relationship between RFTs and adverse pregnancy outcomes.

Methods

The laboratory results of the first- and third-trimester RFTs, including blood urea nitrogen (BUN), serum uric acid (UA), creatinine (Crea) and cystatin C (Cys C), and the relevant medical records, were retrieved from 29,328 singleton and 840 twin pregnant women who underwent antenatal examinations from November 20, 2017 to January 31, 2021. The trimester-specific RIs of RFTs were estimated with both of the direct observational and the indirect Hoffmann methods. The associations between RTFs and pregnancy complications as well as perinatal outcomes were assessed by logistic regression analysis.

Results

Maternal RFTs showed no significant difference between the direct RIs established with healthy pregnant women and the calculated RIs derived from the Hoffmann method. In addition, elevated levels of RFTs were associated with increased risks of developing various pregnancy complications and adverse perinatal outcomes. Notably, elevated third-trimester RFTs posed strong risks of preterm birth (PTB) and fetal growth restriction (FGR).

Conclusions

We established the trimester-specific RIs of RFTs in both singleton and twin pregnancies. Our risk analysis findings underscored the importance of RFTs in identifying women at high risks of developing adverse complications or outcomes during pregnancy.

Keywords: adverse outcome; complication; population-based; pregnancy; reference interval; renal function test
Corresponding authors: Zheng Cao, Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, P.R. China; Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, P.R. China, E-mail: ; Shaofei Su, Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, P.R. China, E-mail: ; Yanhong Zhai, Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, P.R. China; and Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, 251 Yaojiayuan Road, 100026 Beijing, P.R. China, Phone: +86 10 52276406, E-mail:
Zhengwen Xu and He S. Yang contributed equally to this work.

Funding source: Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Award Identifier / Grant number: XKGG201802

Funding source: Capital Medical University

Award Identifier / Grant number: CCMU2022ZKYXZ006

Funding source: Beijing Municipal Administration of Hospitals Incubating Program

Award Identifier / Grant number: PX2020060

  1. Research funding: This work was supported by the Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University (CCMU2022ZKYXZ006), the Beijing Municipal Administration of Hospitals Incubating Program (No. PX2020060) and Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital ‘Discipline Backbone’ Plan Special Funds (No. XKGG201802). The funding bodies did not take part in the design of the study, the collection, analysis and interpretation of the data, or manuscript writing.

  2. Author contributions: Zhengwen Xu: conceptualization, data curation, writing-original draft. He S. Yang: conceptualization, writing-review & editing. Yifan Lu: investigation, methodology. Lanlan Meng, Lin Liu, Lican Han and Guodong Tang: data curation. Jing Wang, Lu Chen and Yue Zhang: data curation, investigation. Yanhong Zhai: conceptualization, data curation, project administration. Shaofei Su: investigation, methodology. Zheng Cao: conceptualization, supervision, funding acquisition, writing – review & editing.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: The need for informed consent from included individuals was waived by the Ethics Committee of Beijing Obstetrics and Gynecology Hospital as all the data used in this study was anonymized before its use.

  5. Ethical approval: The study protocol was approved by the Ethics Committee of Beijing Obstetrics and Gynecology Hospital (2022-KY-007-02).

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2023-0104).

Received: 2023-01-29
Accepted: 2023-03-27
Published Online: 2023-04-06
Published in Print: 2023-09-26

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2023-0104
Keywords for this article
adverse outcome; complication; population-based; pregnancy; reference interval; renal function test

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Laboratory Medicine: from just testing to saving lives
  4. Reviews
  5. Serum biomarkers of remodeling in severe asthma with fixed airway obstruction and the potential role of KL-6
  6. Safety monitoring of drug-induced muscle injury and rhabdomyolysis: a biomarker-guided approach for clinical practice and drug trials
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  13. veRification: an R Shiny application for laboratory method verification and validation
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