Obstetric Nephrology

Mathiesen, Elisabeth R.; Ringholm, Lene; Feldt‐Rasmussen, Bo; Clausen, Peter; Damm, Peter

doi:10.2215/cjn.00920112

Cited by 46 publications

(27 citation statements)

References 66 publications

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“…A review of the literature of the last decade underlines not only the persistence of a higher risk for adverse pregnancy-related outcomes compared to non-diabetic pregnancies, but also raises new questions about an increase in fetal malformations in patients with diabetic nephropathy [12][13][14][15][16][17][18][19][20]. Most of the studies published so far on diabetic nephropathy during pregnancy were designed in a diabetology setting, ideal for the identification and follow-up of early diabetic nephropathy.…”

Section: Introductionmentioning

confidence: 99%

Severe Diabetic Nephropathy in Type 1 Diabetes and Pregnancy - A Case Series

Piccoli¹,

Tavassoli²,

Melluzza³

et al. 2013

Rev Diabet Stud

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Section: Introductionmentioning

confidence: 99%

Severe Diabetic Nephropathy in Type 1 Diabetes and Pregnancy - A Case Series

Piccoli¹,

Tavassoli²,

Melluzza³

et al. 2013

Rev Diabet Stud

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“…The chance of women with diabetic nephropathy having a 'take home baby' is thus very high. Other studies have demonstrated that the risk of pregnancy-induced deterioration of diabetic nephropathy is low if women enter the pregnancy with a serum creatinine level <200 μmol/l [3], and only one woman received dialysis treatment in the present cohort of pregnant women [1].…”

mentioning

confidence: 60%

Diabetic nephropathy in pregnancy: new insights from a retrospective cohort study

Mathiesen

2015

Diabetologia

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In this issue of Diabetologia, Klemetti and colleagues [1] present the results of the largest evaluation of clinical care in pregnant women with type 1 diabetes and diabetic nephropathy ever. This paper adds knowledge about the outcome, in present time, of these diabetic patients. The study is population based and covers more than 100 pregnant women with type 1 diabetes and nephropathy. A careful and proper evaluation of patient records was conducted, and the paper comes from a well-known centre with a long tradition for research and development within the field of diabetes and pregnancy.The good news is that the perinatal mortality rate is reported to be 3% for these patients. This rate is comparable with that for diabetic patients without kidney involvement [2]. Advancements in ultrasound fetal flow measurements may have contributed to the prevention of stillbirths, and the intensification of the care of preterm infants may have contributed to the prevention of early neonatal deaths. The chance of women with diabetic nephropathy having a 'take home baby' is thus very high. Other studies have demonstrated that the risk of pregnancy-induced deterioration of diabetic nephropathy is low if women enter the pregnancy with a serum creatinine level <200 μmol/l [3], and only one woman received dialysis treatment in the present cohort of pregnant women [1].This paper provides further evidence that intensive antihypertensive treatment during pregnancy is probably beneficial in these vulnerable women. Preterm delivery before 32 weeks was seen in 21% of the cases in this cohort during 2000-2011, and preterm delivery before 37 weeks was very common (>70%), mainly due to severe hypertensive disorders. This leaves room for improvement. The majority of women in the present cohort did not receive antihypertensive treatment in early pregnancy. This strategy is often appropriate in women with mild essential hypertension, and is recommended in many international guidelines for antihypertensive treatment in pregnancy. The main reasons for this recommendation are that antihypertensive treatment may induce fetal growth restriction and that it is desirable to limit the use of medications that pass the placenta to the fetus. However, this may not be an effective approach in women with severe hypertension and kidney involvement, such as women with diabetic nephropathy. Blood pressure was within the target of 130/80 mmHg in only 39% of the cohort in early pregnancy, and a high proportion developed severe hypertension with a high level of nephrotic proteinuria in late pregnancy.In logistic regression analysis, first trimester blood pressure above 130/80 mmHg and the last HbA 1c before delivery were associated with preterm birth before 37 gestational weeks. Furthermore, total urine protein excretion in the second and third trimesters correlated negatively with gestational age at birth. This paper thus supports the notion that in addition to the impact of poor glycaemic control uncontrolled hypertension might also contribute to the high pre...

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“…Patients presenting Patients should be advised that advanced kidney disease significantly increases the risk of complications during pregnancy, including preeclampsia and premature birth. Moreover, the risk correlates with the stage of kidney disease; there are also studies describing the progression of kidney disease during pregnancy [7][8][9].…”

Section: Evaluation Of Kidney Functionmentioning

confidence: 99%