Improved Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria or Diabetic Nephropathy

Ringholm, Lene; Damm, Peter; Mathiesen, Elisabeth R.

doi:10.2337/dc08-1526

Cited by 197 publications

(49 citation statements)

References 25 publications

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“…HbA 1c was measured on a DCA 2000 analyzer by a latex immunoagglutination inhibition method (DCA 2000; Bayer, Mishawaka, IN). Blood pressure was measured as formerly described (25), and if >135/85 mmHg, treatment was initiated (29). Elevated urine albumin excretion was defined as albumin-to-creatinine ratio ≥30 mg/mmol in a random urine sample (25).…”

Section: Methodsmentioning

confidence: 99%

The Effect of Real-Time Continuous Glucose Monitoring in Pregnant Women With Diabetes

et al. 2013

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OBJECTIVETo assess whether intermittent real-time continuous glucose monitoring (CGM) improves glycemic control and pregnancy outcome in unselected women with pregestational diabetes.RESEARCH DESIGN AND METHODSA total of 123 women with type 1 diabetes and 31 women with type 2 diabetes were randomized to use real-time CGM for 6 days at 8, 12, 21, 27, and 33 weeks in addition to routine care, including self-monitored plasma glucose seven times daily, or routine care only. To optimize glycemic control, real-time CGM readings were evaluated by a diabetes caregiver. HbA1c, self-monitored plasma glucose, severe hypoglycemia, and pregnancy outcomes were recorded, with large-for-gestational-age infants as the primary outcome.RESULTSWomen assigned to real-time CGM (n = 79) had baseline HbA1c similar to that of women in the control arm (n = 75) (median 6.6 [range 5.3–10.0] vs. 6.8% [5.3–10.7]; P = 0.67) (49 [34–86] vs. 51 mmol/mol [34–93]). Forty-nine (64%) women used real-time CGM per protocol. At 33 weeks, HbA1c (6.1 [5.1–7.8] vs. 6.1% [4.8–8.2]; P = 0.39) (43 [32–62] vs. 43 mmol/mol [29–66]) and self-monitored plasma glucose (6.2 [4.7–7.9] vs. 6.2 mmol/L [4.9–7.9]; P = 0.64) were comparable regardless of real-time CGM use, and a similar fraction of women had experienced severe hypoglycemia (16 vs. 16%; P = 0.91). The prevalence of large-for-gestational-age infants (45 vs. 34%; P = 0.19) and other perinatal outcomes were comparable between the arms.CONCLUSIONSIn this randomized trial, intermittent use of real-time CGM in pregnancy, in addition to self-monitored plasma glucose seven times daily, did not improve glycemic control or pregnancy outcome in women with pregestational diabetes.

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Section: Methodsmentioning

confidence: 99%

The Effect of Real-Time Continuous Glucose Monitoring in Pregnant Women With Diabetes

et al. 2013

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“…If ACE inhibitors were withdrawn during prepregnancy planning, another antihypertensive therapy was initiated unless the urinary albumin-creatinine ratio was close to normal (22). …”

Section: Methodsmentioning

confidence: 99%

“…If given before pregnancy, furosemide or thiazide was continued during pregnancy to reduce the risk of rebound fluid retention with increased blood pressure and urinary albumin excretion when discontinuing the drug (14,22). …”

Section: Methodsmentioning

confidence: 99%

“…Using this strategy, observational studies have shown that early initiation of intensive antihypertensive therapy during pregnancy leads to a reduced prevalence of preterm delivery in women with type 1 diabetes and diabetic nephropathy or microalbuminuria (14,22). Brown and Garovic (23) also recommend a lower threshold for antihypertensive treatment in pregnant women with diabetes and kidney involvement compared with nondiabetic pregnant women.…”

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confidence: 99%

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Diabetic Nephropathy and Microalbuminuria in Pregnant Women With Type 1 and Type 2 Diabetes

Damm¹,

Àsbjörnsdóttir

Callesen

et al. 2013

Diabetes Care

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OBJECTIVETo evaluate the prevalence of diabetic nephropathy and microalbuminuria in pregnant women with type 2 diabetes in comparison with type 1 diabetes and to describe pregnancy outcomes in these women following the same antihypertensive protocol.RESEARCH DESIGN AND METHODSAmong 220 women with type 2 diabetes and 445 women with type 1 diabetes giving birth from 2007–2012, 41 women had diabetic nephropathy (albumin-creatinine ratio ≥300 mg/g) or microalbuminuria (albumin-creatinine ratio 30–299 mg/g) in early pregnancy. Antihypertensive therapy was initiated if blood pressure ≥135/85 mmHg or albumin-creatinine ratio ≥300 mg/g.RESULTSThe prevalence of diabetic nephropathy was 2.3% (5 of 220) in women with type 2 diabetes and 2.5% (11 of 445) in women with type 1 diabetes (P = 1.00). The figures for microalbuminuria were 4.5 (10 of 220) vs. 3.4% (15 of 445) (P = 0.39). Baseline glycemic control was comparable between women with type 2 diabetes (n = 15) and type 1 diabetes (n = 26). Blood pressure at baseline was median 128 (range 100–164)/81 (68–91) vs. 132 (100–176)/80 (63–100) mmHg (not significant) and antihypertensive therapy in type 2 versus type 1 diabetes was used in 0 and 62%, respectively, at baseline, increasing to 33 and 96%, respectively, in late pregnancy. Pregnancy outcome was comparable regardless type of diabetes; gestational age at delivery: 259 days (221–276) vs. 257 (184–271) (P = 0.19); birth weight 3,304 g (1,278–3,914) vs. 2,850 (370–4,180) (P = 0.67).CONCLUSIONSThe prevalence of diabetic nephropathy and microalbuminuria in early pregnancy was similar in type 2 and type 1 diabetes. Antihypertensive therapy was used more frequently in type 1 diabetes. Pregnancy outcome was comparable regardless type of diabetes.

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“…Contraceptive counseling should reinforce the risk for first trimester congenital malformations associated with ACE and ARB therapies and the need to switch immediately to alternative safer therapy during pregnancy. [97,98] Young women who have uncontrolled hypertension or MA are at increased risk for preeclampsia, premature delivery and lower infant birth weight in addition to the increased pregnancy complications and congenital anomalies related to diabetes in their offspring. [99,100]…”

Section: Medical Management Challenges In Youth and Young Adultsmentioning

confidence: 99%

Nephropathy in Youth and Young Adults with Type 2 Diabetes

Solis‐Herrera

Triplitt

Lynch³

2014

Curr Diab Rep

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The occurrence and progression of nephropathy associated with early onset type 2 diabetes is a consequence of the ongoing epidemic of childhood obesity. Minimal evidence regarding treatment effectiveness of renovascular comorbidities in youth with early onset T2D is available, due to the relatively recent emergence of T2D in youth and young adults. Extrapolation of adult therapy guidelines is not an ideal approach to making therapeutic decisions in this population. Evolving management and intervention strategies are based on accumulating longitudinal data from cohorts of well characterized youth and young adults with T2D. The degree of similarity in histologic findings and disease specific characteristics of kidney disease in patients with early onset T2D and albuminuria compared to affected adults is not well characterized. Early aggressive therapies to minimize the impact of nephropathy are indicated as the evidence for best therapies in youth with T2D are further explored.

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Improved Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria or Diabetic Nephropathy

Cited by 197 publications

References 25 publications

The Effect of Real-Time Continuous Glucose Monitoring in Pregnant Women With Diabetes

The Effect of Real-Time Continuous Glucose Monitoring in Pregnant Women With Diabetes

Diabetic Nephropathy and Microalbuminuria in Pregnant Women With Type 1 and Type 2 Diabetes

Nephropathy in Youth and Young Adults with Type 2 Diabetes

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