Second Trimester Kidney Function and Adverse Pregnancy Outcomes among Patients with Lupus
Bibliographic record
Abstract
Key Points In our combined cohort, second trimester kidney function was associated with adverse outcomes for patients with lupus. Measurement of kidney function during pregnancy may have potential benefit, especially among patients without kidney disease. Background Kidney function is not routinely assessed during pregnancy. Several studies have proposed antepartum kidney function, particularly second trimester kidney function, as a potential predictor of adverse pregnancy outcomes. It has been previously established that patients with systemic lupus erythematosus are at increased risk for adverse pregnancy outcomes. The association between second trimester kidney function and adverse pregnancy outcomes has not been evaluated in diverse patient populations, particularly among patients with high obstetrical risk. Methods In this observational study of pregnant patients with lupus in North America and Europe from 1995 to 2017, we used second trimester creatinine and eGFR to model the log odds of preeclampsia, preterm birth, low birthweight, fetal loss, and a composite of those outcomes. We incorporated these measures into a regression setting using fractional polynomials, and we further examined discrete formulations of eGFR. Results Among 684 pregnancies in patients with lupus, the mean second trimester creatinine was 0.63 mg/dl ±SD 0.26 and the median value 0.60 (interquartile range, 0.50–0.70). At least 1 in 3 patients in this combined cohort experienced an adverse outcome. Mixtures of U-shaped and linear relationships between continuous kidney function and the log odds of adverse pregnancy outcomes were observed. Stratifying the cohort by diagnosis of lupus nephritis (LN; active or in remission) or without diagnosis of nephritis, we found differences in the relationship between kidney function and adverse outcomes. Conclusions We observed high rates of adverse pregnancy outcomes in our diverse patient population comprised of pregnant patients with lupus with and without LN. We identified complex relationships between second trimester kidney function and adverse pregnancy outcomes that differed by the outcome and diagnosis of LN.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".