Anti-hypertensive treatment in pregnancy and the risk of acute kidney injury

Approximately 6% of pregnant women have high blood pressure (hypertension) in pregnancy. Hypertension during pregnancy can progress to pre-eclampsia, a severe onset of high blood pressure which can affect multiple organ systems and can cause seizures. Physicians routinely treat women with anti-hypertensive medications to lower their blood pressure. Both Canada and the United Kingdom have advocated for more aggressive treatment of hypertension in pregnancy, which have improved certain aspects of maternal and newborn health; however, the potential for a rare adverse outcome such as acute kidney injury has not been adequately studied. My doctoral thesis found a dramatic increase in the rate of acute kidney injury among women with pre-eclampsia in Canada. Acute kidney injury is a rapid deterioration of the function of the kidneys, the key organ for filtering waste products from the blood and maintaining electrolyte balance. The increase is concerning because acute kidney injury is a serious condition associated with long hospital stays and a high death rate. I aim to find out whether changes in anti-hypertensive treatments explained the recent rise in acute kidney injury. I will analyze de-identified data in Quebec and the United Kingdom, which contain information on doctor and hospital visits and drug prescriptions among pregnant women. This will be the first study to explore this issue in a large database. Findings from this research will help health care providers understand the risks of prescribing anti-hypertensive medication in pregnancy and to make the safest decisions about treating hypertension in pregnancy. Overall, this research will provide evidence which may help improve the health of women and newborns.