Pregnancies in women with diabetic nephropathy: long-term outcome for mother and child

Abstract

In order to improve the basis upon which to advise women with diabetic nephropathy about pregnancy, we studied the effect of diabetic nephropathy on the course of pregnancy, perinatal outcome, infant development and long-term outcome of the mothers. All pregnancies of women with diabetic nephropathy (defined as proteinuria > 400 mg/day (n = 26), creatinine clearance < 80 ml/min and hypertension in the first trimester (n = 10)) followed at our centre from 1982 to 1992 were identified (34 White class F and 2 White class T) and the women and their children re-examined in the spring 1993. From the first to the third trimester the percentage of women with proteinuria over 3 g/day increased from 14 to 53% and those treated with antihypertensive medication from 53 to 97%. There were no intrauterine or perinatal deaths, but one child died suddenly 4 weeks postpartum. Of 36 newborns (gestational week at birth 36(3), birth weight 2384(834) g)), 11 were born before week 34 and 8 had respiratory distress syndrome. Renal function in the first trimester, diastolic blood pressure in the third trimester and an HbA1c above normal were predictive of gestational age at delivery and low birth weight (stepwise regression analysis). At follow up of the children (n = 35, age 4.5 (0.4-10) years) the majority (n = 27) were normally developed but seven had psychomotor retardation (four of them major). One child had a severe motor retardation due to a congenital anomaly. At follow up, 21 of the 29 mothers had preserved renal function (creatinine 1.3 (0.8-4.3) mg/dl and 8 had developed end stage renal disease and required dialysis (2 of whom were White class T) within 3 (1-9) years postpartum.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…Women with diabetic nephropathy were more prone to develop preeclampsia in agreement with previous studies (1)(2)(3)(4)6,20). Hod et al (21) reported that in eight highly selected type 1 diabetic women with diabetic nephropathy, ACE inhibition before pregnancy offered a prolonged protective renal effect throughout pregnancy with favorable pregnancy outcome.…”

“…T ype 1 diabetic women with microalbuminuria or diabetic nephropathy are at particular risk of poor pregnancy outcome (1)(2)(3)(4)(5)(6). Diabetic nephropathy is associated with a high risk of gestational hypertension, preeclampsia, and preterm delivery (1)(2)(3)(4)6).…”

“…Diabetic nephropathy is associated with a high risk of gestational hypertension, preeclampsia, and preterm delivery (1)(2)(3)(4)6). Likewise, preeclampsia and preterm delivery occur more frequently in type 1 diabetic women with microalbuminuria (3,5).…”

Pregnancy and progression of diabetic nephropathy

“…It is also well documented that pregnancy in patients with nephropathy induces short-term blood pressure increases and greater proteinuria [6,30]. The predictive power of such abnormalities in our study could not be evaluated because data from our records and from the obstetrical records were incomplete.…”

A Systematic Review and Meta-Analysis of Outcomes of Pregnancy in CKD and CKD Outcomes in Pregnancy

“…Among 23 retrieved studies, 12 (17)(18)(19)(20)(21)(22)24,25,30,32,33) were prospective studies, 7 (24)(25)(26)(27)(28)(29)31,35,37) were retrospective studies, and 4 (23,25,34,36) did not mention whether they were retrospective or prospective. Twelve studies were from European countries, five were from the United States, four were from Asia, and two were from Brazil.…”