Renal tubular acidosis (RTA) complicated pregnancies: A tertiary centre experience

Background Renal tubular acidosis (RTA) is a disorder of renal acid–base regulation causing normal anion gap metabolic acidosis. Among its three types, distal RTA (dRTA) is the most common form. Methods This retrospective case series included pregnancies complicated by RTA managed at Fernandez Hospital, Hyderabad, India, between 2008 and 2024. Maternal and perinatal outcomes data were obtained from medical records. Results Among 133,542 deliveries, 19 pregnancies were complicated by RTA, giving an incidence of 0.014%. All cases were Type I dRTA, with 84% secondary to connective tissue disorders, predominantly Sjögren's syndrome. Recurrent hypokalaemic periodic paralysis was the most common complication. With early diagnosis and meticulous metabolic correction, most women achieved term deliveries with favourable maternal and neonatal outcomes. Conclusions Renal tubular acidosis in pregnancy may worsen due to physiological changes. Untreated disease poses risks from chronic acidosis and electrolyte imbalance. Early recognition and multidisciplinary management are crucial for optimal outcomes.