{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:29:50Z","timestamp":1786480190184,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>CKD carries an increased risk for developing hypertensive disorders of pregnancy in multifetal pregnancies.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>CKD in multifetal pregnancies is associated with a shorter duration of gestation and an increased risk of having a baby small for gestational age.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Multifetal pregnancies are a risk factor for hypertensive disorders of pregnancy compared with singleton gestations in patients living with CKD.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>CKD is a risk factor for adverse pregnancy outcomes in singleton pregnancies. Little is known about multifetal pregnancies in women with CKD. Owing to higher maternal age and the wider use of medically assisted fertilization, multifetal pregnancies are increasing. We aimed to review pregnancy outcomes in the largest multicenter series of multifetal pregnancies in women affected by CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study gathered data from three Italian units with long-standing experience in the follow-up of pregnancy in women with CKD (2000\u20132023). Propensity score-matched (age, parity, body mass index, year of delivery) multifetal low-risk pregnancies and singleton pregnancies served as controls; multifetal pregnancies were also matched for chorionicity, amnionicity, and mode of conception. Intrauterine death of at least one fetus, given the low number of events, was explored in the overall multifetal cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In this propensity score matched-cohort study, 52 multifetal pregnancies in women with CKD were associated with a significantly lower gestational age compared with 104 low-risk non-CKD controls (median 34.0 versus 36.0 gestational weeks [GWs]) and with lower-term delivery rate (9.6% versus 28.8%). Neonatal intensive care unit admission was more frequent in multifetal pregnancies with CKD (50.9% versus 25.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.003). Cox regression and Kaplan\u2013Meier analyses confirmed the independent effect of CKD on gestation duration. In women with CKD, multifetal pregnancies had a markedly shorter gestation than singletons (median 34 versus 39 GW,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.00001), with significantly higher risk of preterm birth &lt;34 GW (odds ratio [OR], 9.733), small for gestational age (OR, 5.155), and neonatal intensive care unit admission (OR, 8.033). The difference was sharper than in low-risk non-CKD pregnancies (35 and 39 GW, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study, the largest assessing the risks of adverse pregnancy outcomes in women with CKD carrying more than one fetus, suggests that multifetal gestation is a strong additional risk. These findings highlight the need for further investigation and demonstrate the importance of careful counseling, particularly in medically assisted reproduction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0000001125","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T17:01:14Z","timestamp":1770051674000},"page":"1316-1327","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Multifetal Pregnancies in Women with CKD"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1705-691X","authenticated-orcid":false,"given":"Matteo","family":"Gianferrari","sequence":"first","affiliation":[{"name":"N\u00e9phrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8733-0760","authenticated-orcid":false,"given":"Rossella","family":"Attini","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, Biella, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1540-4927","authenticated-orcid":false,"given":"Sofia","family":"Roero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Citt\u00e0 della Salute e della Scienza, Ospedale Sant\u2019Anna, Universit\u00e0 di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7645-8862","authenticated-orcid":false,"given":"Costanza","family":"Valentini","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Citt\u00e0 della Salute e della Scienza, Ospedale Sant\u2019Anna, Universit\u00e0 di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Mariani","sequence":"additional","affiliation":[{"name":"Nephrology, Policlinico Umberto I, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Carta","sequence":"additional","affiliation":[{"name":"Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agata","family":"Ingala","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Citt\u00e0 della Salute e della Scienza, Ospedale Sant\u2019Anna, Universit\u00e0 di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Tomasi Cont","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Citt\u00e0 della Salute e della Scienza, Ospedale Sant\u2019Anna, Universit\u00e0 di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Violetto","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Citt\u00e0 della Salute e della Scienza, Ospedale Sant\u2019Anna, Universit\u00e0 di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2011-2160","authenticated-orcid":false,"given":"Maurizio Alberto","family":"Gallieni","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Department of Biomedical and Clinical Sciences \u201cLuigi Sacco\u201d, Universit\u00e0 di Milano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5797-3722","authenticated-orcid":false,"given":"Alberto","family":"Revelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Citt\u00e0 della Salute e della Scienza, Ospedale Sant\u2019Anna, Universit\u00e0 di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5561-948X","authenticated-orcid":false,"given":"Massimo","family":"Torreggiani","sequence":"additional","affiliation":[{"name":"N\u00e9phrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4853-180X","authenticated-orcid":false,"given":"Antoine","family":"Chatrenet","sequence":"additional","affiliation":[{"name":"APCoSS-Institute of Physical Education and Sports Sciences (IFEPSA), UCO Angers, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Rachele","family":"Rocca","sequence":"additional","affiliation":[{"name":"Nephrology, Policlinico Umberto I, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranca","family":"Cabiddu","sequence":"additional","affiliation":[{"name":"Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Arduino","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Citt\u00e0 della Salute e della Scienza, Ospedale Sant\u2019Anna, Universit\u00e0 di Torino, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2632-4009","authenticated-orcid":false,"given":"Giorgina Barbara","family":"Piccoli","sequence":"additional","affiliation":[{"name":"N\u00e9phrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Kidney and Pregnancy Study Group of the Italian Society of 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