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Maternal obesity is associated with congenital anomalies of the kidney and urinary tract in offspring

Pediatric Nephrology volume 32, pages 635–642 (2017)Cite this article

Abstract

Background

Congenital abnormalities of the kidney and urinary tract (CAKUT) are diagnosed in up to 1 % of pregnancies and account for 20–30 % of the abnormalities identified in the prenatal period. In previous studies, maternal obesity has been associated with congenital malformations in offspring. Our aim was to evaluate the association between maternal obesity [body mass index (BMI) ≥ 30 kg/m2] and CAKUT in offspring.

Methods

We conducted a population-based, case–control study using linked birth–hospital discharge records from Washington State, 2003–2012. We identified 3093 CAKUT cases using International Classification of Diseases, Ninth Revision (ICD-9) codes. Controls were defined as births without any ICD-9 codes denoting congenital malformations, matched to cases by year of birth in an approximate 4:1 ratio.

Results

Compared to controls, mothers giving birth to infants with CAKUT were more likely to be obese [odds ratio (OR) 1.24, 95 % confidence interval (CI) 1.11–1.38]. We found a significant positive trend between odds of CAKUT in offspring and increasing severity of obesity (score test for trend of odds p < 0.001). This association remained significant in offspring with isolated CAKUT (OR 1.19, 95 % CI 1.06–1.35) and upper urinary tract anomalies (OR 1.26, 95 % CI 1.13–1.41). Maternal overweight (BMI 25–29.9 kg/m2) was not associated with CAKUT in offspring.

Conclusions

Our results demonstrate a positive association between maternal obesity and CAKUT in offspring, as well as between obesity severity and the odds of CAKUT in offspring. These findings provide additional evidence for the public health importance of obesity, particularly as a potentially modifiable risk factor.

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References

  1. Finucane M, Stevens G, Cowan M, Danaei G, Lin J, Paciorek C, Singh G, Gutierrez H, Lu Y, Bahalim A (2011) Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 377:557–567

    Article  PubMed  PubMed Central  Google Scholar 

  2. Prospective Studies Collaboration (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373:1083–1096

    Article  PubMed Central  Google Scholar 

  3. Stengel B, Tarver-Carr ME, Powe NR, Eberhardt MS, Brancati FL (2003) Lifestyle factors, obesity and the risk of chronic kidney disease. Epidemiology 14:479–487

    PubMed  Google Scholar 

  4. Hubert HB, Feinleib M, McNamara PM, Castelli WP (1983) Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67:968–977

    Article  CAS  PubMed  Google Scholar 

  5. Sebire NJ, Jolly M, Harris J, Wadsworth J, Joffe M, Beard R, Regan L, Robinson S (2001) Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 25:1175–1182

    Article  CAS  PubMed  Google Scholar 

  6. Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA (2003) Maternal obesity and risk for birth defects. Pediatrics 111[Suppl 1]:1152–1158

    PubMed  Google Scholar 

  7. Waller DK, Shaw GM, Rasmussen SA, Hobbs CA, Canfield MA, Siega-Riz A-M, Gallaway MS, Correa A (2007) Prepregnancy obesity as a risk factor for structural birth defects. Arch Pediatr Adolesc Med 161:745–750

    Article  PubMed  Google Scholar 

  8. Rosendahl H (1990) Ultrasound screening for fetal urinary tract malformations: a prospective study in general population. Eur J Obstet Gynecol Reprod Biol 36:27–33

    Article  CAS  PubMed  Google Scholar 

  9. Queisser-Luft A, Stolz G, Wiesel A, Schlaefer K, Spranger J (2002) Malformations in newborn: results based on 30940 infants and fetuses from the Mainz congenital birth defect monitoring system (1990–1998). Arch Gynecol Obstet 266:163–167

    Article  CAS  PubMed  Google Scholar 

  10. Barakat AJ, Drougas JG (1991) Occurrence of congenital abnormalities of kidney and urinary tract in 13,775 autopsies. Urology 38:347–350

    Article  CAS  PubMed  Google Scholar 

  11. Madarikan B, Hayward C, Roberts G, Lari J (1988) Clinical outcome of fetal uropathy. Arch Dis Child 63:961–963

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. World Health Organization (2000) Obesity: preventing and managing the global epidemic. World Health Organization, Geneva. http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/.

  13. Yaktine AL, Rasmussen KM (2009) Weight gain during pregnancy: Reexamining the guidelines. National Academies Press, Washington DC, pp 241–262

    Google Scholar 

  14. Shnorhavorian M, Bittner R, Wright JL, Schwartz SM (2011) Maternal risk factors for congenital urinary anomalies: results of a population-based case–control study. Urology 78:1156–1161

    Article  PubMed  Google Scholar 

  15. Hsu CW, Yamamoto KT, Henry RK, De Roos AJ, Flynn JT (2014) Prenatal risk factors for childhood CKD. J Am Soc Nephrol 25:2105–2111

    Article  PubMed  PubMed Central  Google Scholar 

  16. Djahangirian O, Khoury A (2016) Duplication Anomalies of the Kidney and Ureters. In: Congenital Anomalies of the Kidney and Urinary Tract. Springer, Geneva, pp 155–173

  17. Cartwright PC (2016) Congenital anomalies of the urinary bladder. In: Congenital anomalies of the kidney and urinary tract. Springer, Geneva, pp 175–195

  18. Al-Harbi A, Winyard P (2016) Anatomy, applied embryology, and pathogenesis of congenital anomalies of the kidney and urinary tract. In: Congenital anomalies of the kidney and urinary tract. Springer, Geneva, pp 15–27

  19. Pope JC, Brock JW, Adams MC, Stephens FD, Ichikawa I (1999) How they begin and how they end classic and new theories for the development and deterioration of congenital anomalies of the kidney and urinary tract, CAKUT. J Am Soc Nephrol 10:2018–2028

    PubMed  Google Scholar 

  20. Stothard KJ, Tennant PW, Bell R, Rankin J (2009) Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. J Am Med Assoc 301:636–650

    Article  CAS  Google Scholar 

  21. Ramakrishnan A, Lee LJ, Mitchell LE, Agopian A (2015) Maternal hypertension during pregnancy and the risk of congenital heart defects in offspring: a systematic review and meta-analysis. Pediatr Cardiol 36:1442–1451

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ornoy A, Reece EA, Pavlinkova G, Kappen C, Miller RK (2015) Effect of maternal diabetes on the embryo, fetus, and children: congenital anomalies, genetic and epigenetic changes and developmental outcomes. Birth Defects Res C Embryo Today 105:53–72

    Article  CAS  PubMed  Google Scholar 

  23. Vujkovic M, Ocke MC, van der Spek PJ, Yazdanpanah N, Steegers EA, Steegers-Theunissen RP (2007) Maternal Western dietary patterns and the risk of developing a cleft lip with or without a cleft palate. Obstet Gynecol 110:378–384

    Article  PubMed  Google Scholar 

  24. Sotres-Alvarez D, Siega-Riz AM, Herring AH, Carmichael SL, Feldkamp ML, Hobbs CA, Olshan AF (2013) Maternal dietary patterns are associated with risk of neural tube and congenital heart defects. Am J Epidemiol 177:1279–1288

    Article  PubMed  PubMed Central  Google Scholar 

  25. Junien C, Nathanielsz P (2007) Report on the IASO Stock Conference 2006: early and lifelong environmental epigenomic programming of metabolic syndrome, obesity and type II diabetes. Obes Rev 8:487–502

    Article  CAS  PubMed  Google Scholar 

  26. Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. J Am Med Assoc 303:235–241

    Article  CAS  Google Scholar 

  27. Honein MA, Devine O, Sharma AJ, Rasmussen SA, Park S, Kucik JE, Boyle C (2013) Modeling the potential public health impact of prepregnancy obesity on adverse fetal and infant outcomes. Obesity 21:1276–1283

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Victoria Holt, PhD, MPH, Stephen Hawes, PhD, MS, Alyson Littman, PhD, MPH, and Bill O’Brien from the Department of Epidemiology, School of Public Health, University of Washington, as well as the Washington State Department of Health. We would like to thanks the National Institute of Diabetes and Digestive and Kidney Diseases for providing fellowship funding for Dr. Macumber (Grant # T32DK007662). We would like to thank Joseph Flynn, MD, MS, from Seattle Children’s Hospital for editorial review of the manuscript.

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Authors and Affiliations

  1. Division of Nephrology, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS#40, Los Angeles, CA, 90027, USA

    Ian Macumber

  2. Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences F-261F, Seattle, WA, 98195, USA

    Stephen Schwartz

  3. Division of Nephrology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Nicolae Leca

Authors
  1. Ian Macumber
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  2. Stephen Schwartz
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  3. Nicolae Leca
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Corresponding author

Correspondence to Ian Macumber.

Ethics declarations

The study was approved by the University of Washington Human Subjects Division and deemed exempt from review by the Institutional Review Board as the data accessed were anonymous and did not allow identification by the authors of individual patients or their medical charts.

Disclosures

The authors have no competing financial interests to disclose.

Conflict of interest

The authors declare that they have no conflict of interest.

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Macumber, I., Schwartz, S. & Leca, N. Maternal obesity is associated with congenital anomalies of the kidney and urinary tract in offspring. Pediatr Nephrol 32, 635–642 (2017). https://doi.org/10.1007/s00467-016-3543-x

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  • DOI: https://doi.org/10.1007/s00467-016-3543-x

Keywords

  • Obesity
  • Maternal obesity
  • Congenital anomalies of kidney and urinary tract
  • CAKUT
  • Chronic kidney disease