Pregnancy complicated by diabetic nephropathy

Dicker, Dov; Feldberg, Dov; Peleg, David; Karp, M; Goldman, Jack A.

doi:10.1515/jpme.1986.14.5.299

Cited by 14 publications

(4 citation statements)

References 16 publications

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“…Similar results to Kitzmiller et al were found by Dicker et al 33 in five patients of White class F in which diabetic nephropathy was diagnosed in the first trimester. In these patients creatinine clearance did not change during gestation, whereas 24-hour protein excretion increased in all patients.…”

Section: Diabetic Nephropathysupporting

confidence: 90%

Impact of Pregnancy on Complications of Insulin-Dependent Diabetes Mellitus

Berk¹,

Miodovnik²,

Mimouni³

1988

Amer J Perinatol

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The effects of pregnancy on acute metabolic complications of diabetes may have important consequences for both mother and fetus. The consequences of pregnancy for chronic complications of diabetes, including retinopathy, nephropathy, neuropathy, and hypertension, are not clear. Recent data are reviewed so that health care providers will be able to provide reasonable advice to insulin-dependent diabetic women contemplating pregnancy both for problems that may potentially arise during gestation and those that may affect long-term health and survival. Diabetic ketoacidosis is an uncommon problem that arises during gestation. Acute alterations in pH and electrolyte concentrations as well as hyperglycemia, however, may have important consequences for mother and fetus, including perinatal asphyxia and reduced fetal oxygen delivery. Hypoglycemia, on the other hand, may result in maternal coma or seizures and, when frequent, has been associated with infant respiratory distress syndrome. Background retinopathy often worsens during gestation, with regression common postpartum. Data suggest that progression of background disease is related to both glycemic control and the acute institution of intensive insulin therapy with those patients with poor control requiring more aggressive therapeutic intervention most adversely affected. The course of proliferative retinopathy is more variable, with both progression and regression reported. Preconception photocoagulation may prevent progression. Preconceptional ophthalmologic evaluation with frequent assessments during pregnancy is advised. Increases in 24-hour protein excretion are common during gestation in patients with preexisting renal disease and resolve in many patients postpartum. Serum creatinine and creatinine clearance increase during the first trimester and generally do not change during the remainder of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Diabetic Nephropathysupporting

confidence: 90%

Impact of Pregnancy on Complications of Insulin-Dependent Diabetes Mellitus

Berk¹,

Miodovnik²,

Mimouni³

1988

Amer J Perinatol

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“…Therefore, in women with well-controlled diabetes who do not have nephropathy or other advanced vascular complications their decision about whether or not to have children will largely be influenced by factors not associated with diabetes itself. In contrast, for women with diabetic nephropathy (who in most cases also have proliferative retinopa- death, c Significantly different at thy) concern about fetal and maternal complications remains a major issue [1][2][3]. Despite substantial improvements in perinatal survival with normoglycaemic control, treatment of hypertension and modern methods of assessment of fetal well-being and perinatal care, there is still a high rate of fetal morbidity largely due to prematurity [3].…”

mentioning

confidence: 99%

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

et al. 1995

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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)

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“…According to four previous reports, the fetal outcome of pregnancies for mothers with diabetic nephropathy has substantially improved since the 1970's compared to the 1960's when perinatal survival rates were below 70 % [1][2][3][5][6][7]. In our series of 36 pregnancies of 29 mothers there were no perinatal or intrauterine deaths but prematurity and associated perinatal morbidity was considerably higher than in pregnancies of diabetic women without nephropathy.…”

Section: Discussionmentioning

confidence: 66%

“…Age (years) Duration of diabetes (years) Planned pregnancies (n) Women with irregular menstrual periods (n) Gestations/primipari (n) Initial visit to diabetic pregnancy clinic (gestational week) Elective abortion for medical reasons (n) thy) concern about fetal and maternal complications remains a major issue [1][2][3]. Despite substantial improvements in perinatal survival with normoglycaemic control, treatment of hypertension and modern methods of assessment of fetal well-being and perinatal care, there is still a high rate of fetal morbidity largely due to prematurity [3].…”

Section: With Nephropathy Without Nephropathy Pregnancies~women (N)mentioning

confidence: 99%

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

et al. 1995

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SummaryIn 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 HbAlc 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. Of those, 4 women (3 White F and i White T) had died. Pregnancy did not seem to specifically accelerate the rate of decline of renal function. In women with diabetic nephropathy perinatal mortality can be prevented but perinatal and long-term infant morbidity remains elevated. Women with severely impaired renal function before pregnancy are at risk for serious morbidity when their children are still young. Improvement might be made if all women were to receive specialized care and counselling before, throughout and after pregnancy. [Diabetologia (1995) Today the perinatal outcome of pregnancies of diabetic women without advanced diabetic complications is similar to that in non-diabetic women, if there is normoglycaemic control throughout pregnancy. Therefore, in women with well-controlled diabetes who do not have nephropathy or other advanced vascular complications their decision about whether or not to have children will largely be influenced by factors not associated with diabetes itself. In contrast, for women with diabetic nephropathy (who in most cases also have proliferative retinopa-

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Pregnancy complicated by diabetic nephropathy

Cited by 14 publications

References 16 publications

Impact of Pregnancy on Complications of Insulin-Dependent Diabetes Mellitus

Impact of Pregnancy on Complications of Insulin-Dependent Diabetes Mellitus

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

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

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