Impact of maternal health on neonatal and long-term kidney outcomes

Abstract

The increasing prevalence of non-communicable diseases like chronic kidney disease signals the need for a deeper understanding of the impact of the intra-uterine milieu on developmental programming and its impact on health outcomes through the lifespan of an individual. Maternal health in the pre-gestational and gestational phases, including nutrition, exposure to drugs, environmental toxins, infectious and non-infectious diseases, and socio-economic conditions influence the overall development of the fetus as well as the fetal kidney. The small, vulnerable newborn, born from an adverse developmental environment, is predisposed to low nephron number and is at risk for acute kidney injury in the neonatal period. Developmental programming has far-reaching consequences, including a higher risk for cardio-kidney-metabolic diseases, including hypertension and chronic kidney disease, and pregnancy complications, which perpetuates an intergenerational cycle of non-communicable disease risk. This risk can be mitigated by optimizing the care of individuals in the reproductive age group, identifying high-risk pregnancies early, and providing optimal treatment and monitoring. Care of the small vulnerable neonate includes prevention of acute kidney injury and life-long surveillance and modulation of cardio-kidney-metabolic risk. The review focuses on highlighting the influence of maternal health in the pre-gestational and gestational phases on kidney health from the neonatal period to adulthood.

Keywords: Chronic kidney disease; Low birth weight; Neonatal acute kidney injury; Nephron number; Preeclampsia; Preterm birth; Small vulnerable newborn.