TOPLINE:

Women with chronic kidney disease (CKD) and multifoetal pregnancies had a significantly lower gestational age at delivery and higher rates of NICU admission than those with low-risk multifoetal pregnancies without CKD. Among women with CKD stage 1, multifoetal pregnancy was linked to increased odds of very early preterm delivery, having a baby born small for gestational age (SGA), and NICU admission.

METHODOLOGY:

• This observational cohort study assessed the risk for adverse pregnancy outcomes in women with CKD and multifoetal pregnancies.
• They included 52 women with CKD and multifoetal pregnancies (median age at the start of pregnancy, 33 years) and compared them with 104 matched control women with low-risk multifoetal pregnancies without CKD.
• Furthermore, 41 women with CKD stage 1 and multifoetal pregnancies were compared to three matched control groups: those with low-risk multifoetal pregnancies without CKD, singleton pregnancies with CKD stage 1, and low-risk singleton pregnancies without CKD.
• Main outcomes were the gestational age at delivery, rate of preterm birth (< 34 weeks of gestation), prevalence of babies born SGA, and need for NICU admission.
• Intrauterine death of at least one foetus was also analysed in the overall cohorts of multifoetal pregnancies due to the low number of events.

TAKEAWAY:

• Women with CKD and multifoetal pregnancies had a significantly lower median gestational age at delivery than those with low-risk multifoetal pregnancies without CKD (34.0 vs 36.0 weeks; P = .006).
• Rates of NICU admission were also significantly higher in the CKD stage 1 multifoetal pregnancy group than in the low-risk non-CKD multifoetal control group (50.9% vs 25.2%; P = .001).
• In women with CKD stage 1, multifoetal pregnancy was independently associated with increased odds of delivery before 34 weeks (odds ratio [OR], 9.733), having at least one baby born SGA (OR, 5.155), and requiring NICU admission for at least one newborn (OR, 8.033).
• The occurrence of intrauterine foetal death of at least one twin was significantly higher in women with CKD than in those without (12.96% vs 3.60%; OR, 3.99).

IN PRACTICE:

"The additive risks of APOs [adverse pregnancy outcomes] in multifetal pregnancies in women living with CKD should be highlighted in counselling, especially in the case of assisted fertilization, and suggest a very cautious attitude towards multiple egg transfers in women affected by even early and mild CKD," the authors wrote.

SOURCE:

This study was led by Matteo Gianferrari, Centre Hospitalier Le Mans, Le Mans, France. It was published online on February 02, 2026, in Kidney360.

LIMITATIONS:

The relatively small sample size and data from a single country with a predominantly White population limited generalisability. The low number of patients with advanced CKD stages prevented stratification by assisted fertilisation techniques. Additionally, the retrospective design may have introduced inherent biases and residual confounding.

DISCLOSURES:

This study did not report any specific funding. Some authors reported receiving honoraria or research funding or having other ties with various organisations. Six authors reported having employment at academic or medical institutions.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.