Diabetic nephropathy and perinatal outcome

Kitzmiller, John L.; Brown, Elizabeth R.; Phillippe, Mark; Stark, Ann R.; Acker, David; Kaldany, A; Singh, S.; Hare, John

doi:10.1016/0002-9378(81)90698-0

Cited by 142 publications

(71 citation statements)

References 13 publications

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“…Poor glycaemic control increases the risk of congenital malformations [30,31], preterm delivery [32] and pre-eclampsia [33], all of which were common in our study. The rate of fetal malformations was close to the levels reported 30 years ago [5,8]. Since the physiological decrease in HbA 1c during pregnancy is minimal [34], the marked decrease of early pregnancy HbA 1c levels by mid-pregnancy demonstrates that improvement in glycaemic control is possible in patients with diabetic nephropathy.…”

Section: Discussionmentioning

confidence: 51%

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Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

et al. 2015

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Aims/hypothesis Our aim was to analyse possible changes in the glycaemic control, BP, markers of renal function, and obstetric and perinatal outcomes of parturients with diabetic nephropathy during 1988-2011. Methods The most recent childbirth of 108 consecutive type 1 diabetes patients with diabetic nephropathy and a singleton pregnancy were studied. Two periods, 1988Two periods, -1999Two periods, and 2000Two periods, -2011 . Antihypertensive medication usage increased before pregnancy (34% vs 65%, p=0.002) and in the second and third trimesters of pregnancy (25% vs 47%, p=0.02, and 36% vs 60%, p =0.01, respectively). BP exceeded 130/ 80 mmHg in 62% and 61% (p=0.87) of patients in the first trimester, and in 95% and 93% (p=0.69) in the third trimester, respectively. No changes were observed in the markers of renal function. Pre-eclampsia (52% vs 42%, p=0.29) and preterm birth rates before 32 and 37 gestational weeks (14% vs 21%, p=0.33, and 71% vs 77%, p=0.49, respectively) remained high. The elective and emergency Caesarean section rates were 71% and 45% (p=0.01) and 29% and 48% (p= 0.05), respectively. Neonatal intensive care unit admissions increased from 26% to 49% (p=0.02). Conclusions/interpretation Early pregnancy glycaemic control and hypertension management were suboptimal in both time periods. Pre-eclampsia and preterm delivery rates remained high in patients with diabetic nephropathy.

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Section: Discussionmentioning

confidence: 51%

“…Diabetic nephropathy, which complicates 2.5-5% of type 1 diabetes pregnancies [3,4], is associated with a particularly high risk of hypertensive disorders of pregnancy, preterm birth, intrauterine growth restriction and perinatal mortality [4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

et al. 2015

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“…Superimposed preeclampsia, which is associated with preterm delivery and intrauterine growth retardation (4,9,10), is a significant problem in women with diabetic nephropathy (4,8,11). Diabetic women with high early pregnancy proteinuria of 190 -499 mg/day have been reported to have an increased risk of developing preeclampsia, similar to that in women with diabetic nephropathy (11).…”

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confidence: 99%

Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria

Ekbom¹,

Damm²,

et al. 2001

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OBJECTIVE -To determine the influence of microalbuminuria on pregnancy outcome in women with type 1 diabetes.RESEARCH DESIGN AND METHODS -This prospective cohort study took place at the Obstetric Clinic at National University Hospital, Copenhagen, from January 1996 to February 2000. All Caucasian women with type 1 diabetes, unselected from the eastern part of Denmark, with a living fetus before 17 weeks of gestation on admission were asked to participate. For women with more than one delivery in the study period, only the first pregnancy was included. Of the remaining 246 women, 240 (98%) entered the study. They were categorized according to their urinary albumin excretion (normal urinary albumin excretion, Ͻ30 mg/24 h; microalbuminuria, 30 -300 mg/24 h; or diabetic nephropathy, Ͼ300 mg/24 h) before pregnancy or in the first trimester.RESULTS -A total of 203 women (85%) had normal urinary albumin excretion, 26 (11%) had microalbuminuria, and 11 (5%) had diabetic nephropathy. Mean HbA 1c at 2-6 weeks was 7.5% (SD 1.1), 8.1 (0.9), and 8.8 (1.3) (P Ͻ 0.001), respectively. Of all deliveries in women with normal urinary albumin excretion, microalbuminuria, and diabetic nephropathy, 35, 62, and 91% (P Ͻ 0.001), respectively, were preterm, and 2, 4, and 45% (P Ͻ 0.001), respectively, were small-for-gestational-age infants. Preeclampsia developed in 6, 42, and 64% of the women (P Ͻ 0.001), respectively. Category of urinary albumin excretion (P Ͻ 0.01) and HbA 1c at 2-6 weeks (P Ͻ 0.05) were independently associated with preterm delivery.CONCLUSIONS -The prevalence of preterm delivery is considerably increased in women with microalbuminuria, mainly caused by preeclampsia. Classification according to urinary albumin excretion and metabolic control around the time of conception are superior to the White classification in predicting preterm delivery in women with type 1 diabetes.

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“…* with severe microangiopathy. References [64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] Kitzmiller 1981: proteinuria declined >50% in 65.2% 6-35 months after pregnancy White class B: onset at age 20 or older or duration < 10 years; class C: onset at age 10-19 or duration 10-19 years; class D: onset < 10 or duration > 20 years; class E: overt diabetes mellitus with calcified pelvic vessels; class F: diabetic nephropathy; class R: proliferative retinopathy; class RF: retinopathy and nephropathy; class H: ischemic heart disease; class T: prior kidney transplant. Abbreviations: ATG -above target group, BP -blood pressure, BTG -below target group, CCr -creatinine clearance, ctrl -control, DBP -diastolic blood pressure, ESRD -end-stage renal disease, GFR -glomerular filtration rate, DN -diabetic nephropathy, LN -lupus nephritis, MAP -mitogen-activated protein, microalb -microalbimuria, nephro -nephropathy, normoalb -normoalbimuria, NR -not reported, OR -odds ratio, PE -preeclampsia, PN -pyelonephritis, preg -pregnant, prot -proteinuria, PtU -proteinuria, sCr -serum creatinine, SBP -systolic blood pressure, trim -trimester, UAE -urinary albumin excretion, UTI -urinary tract infection, wk -week.…”

Section: ■ Appendixmentioning

confidence: 99%

“…Abbreviations: ATG -above target group, BP -blood pressure, BTG -below target group, CCr -creatinine clearance, ctrl -control, DBP -diastolic blood pressure, ESRD -end-stage renal disease, GFR -glomerular filtration rate, DN -diabetic nephropathy, LN -lupus nephritis, MAP -mitogen-activated protein, microalb -microalbimuria, nephro -nephropathy, normoalb -normoalbimuria, NR -not reported, OR -odds ratio, PE -preeclampsia, PN -pyelonephritis, preg -pregnant, prot -proteinuria, PtU -proteinuria, sCr -serum creatinine, SBP -systolic blood pressure, trim -trimester, UAE -urinary albumin excretion, UTI -urinary tract infection, wk -week. References [12,[46][47][48].…”

Section: ■ Appendixmentioning

confidence: 99%

Type 1 Diabetes, Diabetic Nephropathy, and Pregnancy: A Systematic Review and Meta-Study

Piccoli¹,

Clari²,

Ghiotto³

et al. 2013

Rev Diabet Stud

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■ Abstract BACKGROUND:In the last decade, significant improvements have been achieved in maternal-fetal and diabetic care which make pregnancy possible in an increasing number of type 1 diabetic women with end-organ damage. Optimal counseling is important to make the advancements available to the relevant patients and to ensure the safety of mother and child. A systematic review will help to provide a survey of the available methods and to promote optimal counseling. OBJECTIVES: To review the literature on diabetic nephropathy and pregnancy in type 1 diabetes. METHODS: Medline, Embase, and the Cochrane Library were scanned in November 2012 (MESH, Emtree, and free terms on pregnancy and diabetic nephropathy). Studies were selected that report on pregnancy outcomes in type 1 diabetic patients with diabetic nephropathy in 1980-2012 (i.e. since the detection of microalbuminuria). Case reports with less than 5 cases and reports on kidney grafts were excluded. Paper selection and data extraction were performed in duplicate and matched for consistency. As the relevant reports were highly heterogeneous, we decided to perform a narrative review, with discussions oriented towards the period of publication. RESULTS: Of the 1058 references considered, 34 fulfilled the selection criteria, and one was added from reference lists. The number of cases considered in the reports, which generally involved single-center studies, ranged from 5 to 311. The following issues were significant: (i) the evidence is scattered over many reports of differing format and involving small series (only 2 included over 100 patients), (ii) definitions are non-homogeneous, (iii) risks for pregnancy-related adverse events are increased (preterm delivery, caesarean section, perinatal death, and stillbirth) and do not substantially change over time, except for stillbirth (from over 10% to about 5%), (iv) the increase in risks with nephropathy progression needs confirmation in large homogeneous series, (v) the newly reported increase in malformations in diabetic nephropathy underlines the need for further studies. CONCLUSIONS: The heterogeneous evidence from studies on diabetic nephropathy in pregnancy emphasizes the need for further perspective studies on this issue.

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Diabetic nephropathy and perinatal outcome

Cited by 142 publications

References 13 publications

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria

Type 1 Diabetes, Diabetic Nephropathy, and Pregnancy: A Systematic Review and Meta-Study

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