Understanding the link between kidney health and pregnancy outcomes

生殖健康对妇女的整体健康和福祉非常重要，并日益被认为是今后生活中疾病的性别特异性标志。例如，经历过妊娠并发症的女性，如先兆子痫，在以后的生活中更有可能患心脏病。然而，对于经历过妊娠并发症的女性是否更有可能在以后的生活中出现肾功能下降和肾脏疾病，我们的知识还存在差距。我将使用来自几项研究的信息，包括常规收集的大型临床数据集和具有详细测量的小型研究，来检查在怀孕期间经历不同并发症的妇女在以后的生活中是否有更大的肾功能下降和肾脏疾病的风险。了解妇女生殖健康与后期疾病之间的关系很重要，因为它可以确定在怀孕后加强肾功能监测的必要性，至关重要的是，肾脏疾病的一些原因是可以预防的。然后可以为高危妇女提供降低风险的建议或治疗。对于怀孕前肾功能下降的女性是否有更大的妊娠并发症风险，也存在知识空白。在这里，我将在怀孕前，怀孕早期和整个怀孕期间测量肾功能，以检查肾功能下降的女性是否有更大的妊娠并发症风险，如妊娠前期子痫和糖尿病。这一点很重要，因为越来越多的女性在更大的年龄生育孩子，我们必须了解是什么影响了女性健康怀孕的机会。最后，如果在怀孕期间需要检测肾功能，就要测量血液中一种叫做肌酐的物质。然而，对于怀孕期间的可接受水平并没有明确的指导。我将使用多项研究来解决这一知识差距，并以建立正常/可接受范围为目的。我还将研究另一种肾功能测量方法——胱抑素C。与肌酐不同，胱抑素C由体内所有细胞产生，而不仅仅是肌肉，因此不受肌肉质量等因素的影响。如果在怀孕期间观察到肌酐的变化，这项工作将为如何管理女性提供见解。

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.