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Pre-Conception Hypertension Linked to Adverse Pregnancy Outcomes in IgA Nephropathy
Non-RASi antihypertensive use before pregnancy in women with IgAN increased the risk of severe HDP and preterm delivery.
Recent findings on pregnancy outcomes in women with IgA nephropathy (IgAN) suggest pre-conception use of non-renin-angiotensin-aldosterone system inhibitor (RASi) antihypertensive medications correlates with increased risk of severe hypertensive disorders of pregnancy (HDP) and preterm deliveries, underscoring the importance of optimising blood pressure control in this population.1
The retrospective, observational, case-control study utilized real-world administrative claims data from Medical Data Vision Co. to evaluate whether differences in disease activity, approximated by blood pressure and/or urine protein levels, were associated with increased adverse pregnancy outcomes.
IgAN frequently presents during the 3rd or 4th decade of life, heightening concerns for women planning to conceive. Previous research suggests renal function is preserved during gestation, but patients remain at an elevated risk of complications, including preeclampsia, medically indicated preterm birth, and miscarriage.2,3,4
“This is the largest study to focus on risk factors for adverse pregnancy outcomes in women with IgAN,” wrote Shoichi Maruyama, MD, PhD, a professor of Nagoya University Graduate School of Medicine. “In addition, we used the medication history within six months before conception to estimate the status of blood pressure and urine protein levels. This may be a new perspective that was not considered in previous studies on pregnancy with IgAN.”
Investigators identified patients with chronic kidney disease and examined their hospitalisation records for age, smoking history, pregnancy status, gestational age, and medication history at the time of hospitalisation.
The study included 297 pregnancies in women with IgAN. The case group was defined as patients who received prescriptions for antihypertensive medications and/or glucocorticoid therapy within 6 months before conception, and those with no medication history were treated as the comparison group.
Patients prescribed antihypertensive medications (n = 44) were categorized as “RASi” (n = 32), and “medications other than RASi” (n = 12). For glucocorticoid therapy, groups were categorised as “drip infusion in vein (DIV) or per os (PO),” “only DIV,” and “only PO.” Investigators assumed glucocorticoid therapy/RASi was a determinant of proteinuria and antihypertensive medications for hypertension.
Pregnancy outcomes were defined separately as severe hypertensive disorders of pregnancy requiring intravenous nicardipine and preterm delivery, defined as gestational age <37 weeks.
Upon statistical analysis, among women with IgAN, the need for antihypertensive therapy before conception, specifically “medications other than RASi” was strongly associated with adverse pregnancy outcomes, demonstrating a 5x higher risk of severe hypertensive disorders of pregnancy (adjusted odds ratio [aOR], 5.01; 95% Confidence Interval [CI], 1.43–17.5) and a 6.45 times greater risk of preterm delivery (95% CI, 1.81–23.0).
In contrast, glucocorticoid therapy and RASi use showed no significant association with either preterm delivery or HDP. Antihypertensive medications were discontinued after pregnancy detection in 90.6% of patients receiving RASi but in only 33.3% of those receiving other antihypertensives, underscoring the greater burden of pre-conception hypertension in this higher-risk group.
“To the best of our knowledge, this is the first study to highlight the importance of pre-conception blood pressure management, and the potential of hypertension as a predictor of adverse pregnancy outcomes in women with IgAN who are planning pregnancies,” concluded investigators.
References
Asano Y, Imaizumi T, Fuma K, et al. Risk factors of adverse pregnancy outcomes in patients with immunoglobulin A nephropathy. Scientific Reports. 2025;15(1). doi:https://doi.org/10.1038/s41598-025-21529-x
Jarrick S, Lundberg S, Stephansson O, et al. Pregnancy outcomes in women with immunoglobulin A nephropathy: a nationwide population-based cohort study. Journal of Nephrology. 2021;34(5):1591-1598. doi:https://doi.org/10.1007/s40620-021-00979-2
Liu Y, Ma X, Zheng J, Liu X, Yan T. A Systematic Review and Meta-Analysis of Kidney and Pregnancy Outcomes in IgA Nephropathy. American Journal of Nephrology. 2016;44(3):187-193. doi:https://doi.org/10.1159/000446354
Du X, Tian G, Lu X. Successful pregnancy in a patient with IgA nephropathy treated with telitacicept: a case report. BMC Pregnancy and Childbirth. 2024;24(1):432-432. doi:https://doi.org/10.1186/s12884-024-06632-7
