Supplementary Material for: A Systematic Review and Meta-Analysis of Kidney and Pregnancy Outcomes in IgA Nephropathy

Background: The outcomes of pregnancy in immunoglobulin A nephropathy (IgAN) remain controversial. We sought to evaluate the effect of pregnancy on the progression of IgAN as well as the impact of IgAN on pregnancy outcomes. Methods:We systematically searched MEDLINE, Embase for cohort or case-control studies. OR reductions were calculated with a random-effects model, and kidney outcomes and adverse pregnancy events were analyzed. Results: Our literature search returned 652 relevant articles; 4 studies were included, providing data of 376 pregnancies in 273 patients with IgAN and that of 241 IgAN who did not become pregnant. Four hundred sixty seven patients with chronic kidney disease stages 1-2 were included. Pregnancy in patients with IgAN did not increase the risk of adverse renal events including doubling of serum creatinine, 50% decline in glomerular filtration rate (GFR) and end-stage kidney disease (OR 0.97, 95% CI 0.55-1.70; p = 0.90; I2 = 0.0%, p = 0.79). There was no significant difference in the change in estimated GFR at the end of follow-up in the pregnant and non-pregnant groups (weighted mean difference 0.1 ml/min/1.73 m2 (95% CI -4.85 to 5.04 ml/min/1.73 m2), p = 0.97; I2 = 0%, p = 0.95). Women with IgAN had high rates of infant loss (12.2, 7.4-19.4%), preterm delivery (8.5, 5.9-12.1%), low birth weight (9.5, 6.7-13.3%), and preeclampsia/severe preeclampsia (7.3, 4.9-10.6%). Conclusions: Pregnancy in IgAN patients with preserved kidney function did not accelerate deterioration of renal function. But pregnant women with IgAN are at higher risk of pregnancy complications.

背景：免疫球蛋白A肾病（IgAN）患者的妊娠结局仍存在争议。本研究旨在探讨妊娠对IgAN患者病情进展的影响，以及IgAN本身对妊娠结局的作用。
方法：我们系统检索了MEDLINE、Embase数据库中收录的队列研究或病例对照研究文献。采用随机效应模型计算比值比（Odds Ratio, OR），并对肾脏结局与不良妊娠事件进行分析。
结果：本研究共检索到652篇相关文献，最终纳入4项研究，涵盖273例IgAN患者的376次妊娠数据，以及241例未妊娠的IgAN患者数据，其中包含467例慢性肾脏病1~2期患者。IgAN患者妊娠并未增加不良肾脏事件风险，包括血清肌酐翻倍、肾小球滤过率（glomerular filtration rate, GFR）下降50%及终末期肾病（OR=0.97，95%置信区间CI：0.55~1.70；p=0.90；I²=0.0%，p=0.79）。妊娠组与非妊娠组在随访结束时估算GFR的变化无显著差异（加权均数差为0.1 ml/min/1.73 m²，95%CI：-4.85~5.04 ml/min/1.73 m²，p=0.97；I²=0%，p=0.95）。IgAN女性患者的胎儿丢失率较高（12.2%，95%CI：7.4~19.4%）、早产率为8.5%（95%CI：5.9~12.1%）、低出生体重儿发生率为9.5%（95%CI：6.7~13.3%），且先兆子痫/重度先兆子痫发生率为7.3%（95%CI：4.9~10.6%）。
结论：肾功能保留的IgAN患者妊娠不会加速肾功能恶化，但IgAN妊娠女性发生妊娠并发症的风险更高。