Associations between maternal chronic diseases and congenital anomalies of the kidney and urinary tract in offspring: a population-based cohort study

Hsin-Hsu Chou; Chih-Chia Chen; Ching-Fang Tsai; Pao-Lin Kuo; Yuan-Yow Chiou

doi:10.1093/ckj/sfad217

Associations between maternal chronic diseases and congenital anomalies of the kidney and urinary tract in offspring: a population-based cohort study

Clin Kidney J. 2023 Sep 6;16(12):2652-2660. doi: 10.1093/ckj/sfad217. eCollection 2023 Dec.

Authors

Hsin-Hsu Chou^{1

2}, Chih-Chia Chen^{3

4}, Ching-Fang Tsai⁵, Pao-Lin Kuo⁶, Yuan-Yow Chiou⁴

Affiliations

¹ Department of Pediatrics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi City, Taiwan.
² Department of Bioinformatics and Medical Engineering, Asia University, Taichung City, Taiwan.
³ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
⁴ Department of Pediatrics, Division of Pediatric Nephrology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
⁵ Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi City, Taiwan.
⁶ Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.

Abstract

Background: The relationship between maternal chronic diseases and congenital anomalies of the kidneys and urinary tract (CAKUT) in offspring still needs elucidation. This study aimed to comprehensively evaluate the associations between maternal chronic disease and CAKUT in their offspring.

Methods: Data of mothers and children were extracted from the Taiwan Maternal and Child Health Database and National Health Insurance Research Database. The concept of developmental origins of health and disease (DOHaD) was used to select maternal chronic diseases.

Results: The study cohort included 1 196 175 mothers and 1 628 706 offspring. Analysis showed that maternal chronic diseases, especially type 1 diabetes, type 2 diabetes, gestational diabetes, connective tissue disorders and CAKUT were highly associated with CAKUT in the offspring. Higher maternal age, abnormal birthweight (>3500 g or <2500 g), gestational age <36 weeks and birth order <2 were all associated with a higher risk of CAKUT. Maternal chronic hypertension and taking angiotensin-related drugs increased the odds ratios of obstructive kidney disease in the offspring. Offspring tended to have the same type of CAKUT as their mothers.

Conclusion: Maternal chronic diseases, older maternal age and abnormal birthweight are risk factors for CAKUT. Also, a percentage of patients with CAKUT were not full-term newborns. Results support prenatal counselling and health management of pregnant women with chronic diseases and extra care for infants with a high risk of anomalies. It is strongly recommended that prevention of CAKUT in offspring should start with care of the mothers' prenatal chronic diseases.

Keywords: Maternal and Child Health Database; chronic disease; congenital anomaly of kidney and urinary tract disease (CAKUT); health characteristics; nationwide population-based cohort study.