Outcome of pregnancy in women with a history of vesico-ureteric reflux

OBJECTIVES To review the evidence relating to the outcome of pregnancy in women with vesico-ureteric reflux (VUR) or a previous history of VUR and to identify the factors contributing to morbidity in pregnancy, with particular emphasis on the role of renal scarring. METHODS Searches were carried out in Medline, Pubmed and MID Consult using various combinations of the keywords including vesicoureteral reflux and pregnancy, maternal vesicoureteral reflux, vesicoureteral reflux in adulthood, reflux nephropathy and pregnancy. All data quoted in this review are from original articles. RESULTS The published studies showed that women with VUR that was not associated with renal scarring had no increase in the incidence of gestational hypertension, pre-eclampsia or fetal morbidity, regardless of whether their VUR was diagnosed in childhood or adulthood. However, women with VUR and normal kidneys did have higher incidence of urinary tract infection during pregnancy, which was not modified by ureteric reimplantation. Renal scarring was the primary risk factor for morbidity during pregnancy and this risk was independent of the presence or absence of VUR at the time of pregnancy. CONCLUSION The evidence does not support the practice of correcting low-grade VUR in girls with unscarred kidneys because this will reduce their risk of complications in pregnancy. The presence of renal scarring rather than the presence or absence of reflux is the principal determinant of morbidity during pregnancy.