Understanding the link between kidney health and pregnancy outcomes

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Reproductive health is important to a woman's overall health and well-being and is increasingly recognised as a sex specific marker for diseases in later life. Women who experience complications of pregnancy, such as pre-eclampsia, are more likely to have heart disease in later life for example. However, there are gaps in our knowledge about whether women who experience complications of pregnancy are more likely to experience reduced kidney function and kidney disease in later life. I will use information from several studies, including large datasets of routinely collected clinical data and smaller studies with detailed measurements, to examine if women who experience different complications in pregnancy are at greater risk of reduced kidney function and kidney disease in later life. Understanding the relationship between women's reproductive health and later disease is important as it may identify the need for increased monitoring of kidney function after pregnancy, crucially as some of the causes of kidney disease are preventable. Women at high risk can then be offered advice or treatment that will lower that risk.There are also gaps in knowledge about whether women who have reduced kidney function prior to pregnancy are at greater risk of developing pregnancy complications. Here, I will measure kidney function prior to pregnancy, in early pregnancy, and throughout pregnancy, to examine if women with reduced kidney function are at greater risk of pregnancy complications such as pre-eclampsia and diabetes in pregnancy. This is important as women are increasingly having children at older ages, and it is vital that we understand what affects women's chances of having a healthy pregnancy. Finally, if kidney function needs to be tested in pregnancy, a substance in the blood called creatinine is measured. However, there is no clear guidance on acceptable levels in pregnancy. I will use multiple studies to address this knowledge gap and with the aim of establishing the normal/acceptable range. I will also examine an alternative measures of kidney function, cystatin C. Unlike creatinine, cystatin C is produced from all cells in the body, rather than just muscles, and so isn't affected by things like muscle mass. The work will provide insights into how women should be managed if changes in creatinine are observed during pregnancy.