Which maternal condition increases the risk of renal anomalies in the newborn?

• A. Chronic hypertension
• B. Diabetes
• C. Lupus
• D. Obesity

Answer: (B)

When a fetus forms its kidneys, this happens very early in gestation during organ formation, so the maternal metabolic environment can influence how those structures develop. Diabetes in the mother—especially pregestational diabetes with poor glycemic control—has the strongest link to congenital renal anomalies. High glucose levels during weeks 4 to 8 can disrupt normal nephrogenesis, leading to conditions such as renal agenesis, renal hypoplasia, or dysplasia, and other urinary tract abnormalities. Tight glucose control before and during early pregnancy reduces this risk, which is why diabetes is the best-supported choice for this association.

Chronic hypertension tends to affect the placenta and fetal growth rather than causing a high rate of primary renal malformations. Lupus in pregnancy can lead to neonatal lupus or cardiac issues from maternal antibodies, not a classic pattern of renal structural anomalies. Obesity raises overall risks for various complications, but it does not have as strong a direct link to congenital renal malformations as maternal diabetes does.