Long‐term survival and renal outcomes of thrombotic microangiopathy in pregnancy: A retrospective cohort study

Objective Thrombotic microangiopathy (TMA) in pregnancy can rapidly progress, leading to severe morbidities. This study aimed to compare baseline demographics and clinical outcomes between pregnant women with and without TMA. Methods Using the National Health Insurance Research Database, 207 patient...

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Bibliographic Details
Published in:International journal of gynecology and obstetrics 2023-12, Vol.163 (3), p.940-947
Main Authors: Chen, Hsin‐Yu, Shih, Jin‐Chung, Tsai, Meng‐Han, Chung, Ching‐Hu
Format: Article
Language:English
Subjects:
end‐stage renal disease
pregnancy
survival
thrombotic microangiopathy
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Summary:Objective Thrombotic microangiopathy (TMA) in pregnancy can rapidly progress, leading to severe morbidities. This study aimed to compare baseline demographics and clinical outcomes between pregnant women with and without TMA. Methods Using the National Health Insurance Research Database, 207 patients with pregnancy‐related TMA from January 1, 2006 to December 31, 2015 were enrolled. Their data were compared with a 1:4 propensity score–matched cohort of 828 pregnant women without TMA to evaluate mortality and end‐stage renal disease (ESRD) risks. Cox proportional hazards models were used to estimate the adjusted hazard ratio and 95% confidence intervals. Results A total of 1035 participants were included. The risks of mortality and ESRD were 4.46 and 5.97 times higher for the TMA cohort, respectively. Subgroup analysis revealed higher mortality and ESRD risks in patients with TMA aged >40 years with a history of hypertension, stroke, cancer, concomitant stroke, malignant hypertension, or gastroenterocolitis than in the matched cohort. Conclusion Pregnant patients with TMA, especially those older and with comorbidities and organ involvement, faced increased mortality and ESRD risks. Physicians should collaborate with obstetricians throughout the prenatal and postpartum periods for these patients. Synopsis Patients with pregnant thrombotic microangiopathy, particularly older patients with comorbidities and organ involvement, have an increased risk of mortality and end‐stage renal disease.
ISSN:0020-7292
1879-3479
DOI:10.1002/ijgo.14918