Effects of pregnancy on the onset and progression of diabetic nephropathy and of diabetic nephropathy on pregnancy outcomes

Young, Esther Cytrynbaum; Pires, Maria Lúcia Elias; Marques, Luiz Paulo José; Oliveira, José Egídio Paulo de; Zajdenverg, Lenita

doi:10.1016/j.dsx.2012.02.013

Cited by 35 publications

(24 citation statements)

References 22 publications

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“…Of the 23 studies (n=505,759 pregnancies), 14 (17)(18)(19)(20)(21)(22)27,28,30,32,33,35,37) of the reported adverse maternal or fetal outcomes in pregnant women with CKD. The definition of CKD varied across the studies.…”

Section: Study Selection and General Informationmentioning

confidence: 99%

“…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.…”

Section: Study Selection and General Informationmentioning

confidence: 99%

“…The definition of CKD varied across the studies. Among 14 studies, 8 (17)(18)(19)(20)(21)(22)30,32) enrolled patients diagnosed with diabetic nephropathy (DN) with proteinuria, 3 (33,37) defined CKD according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative definition, 1 defined CKD according to by medical coding (27), and 1 defined CKD by biopsy (35). One study (28) enrolled pregnant women with low kidney LGA, large for gestational age; IUGR, intrauterine growth restriction;…”

Section: Study Selection and General Informationmentioning

confidence: 99%

“…Nine studies (18)(19)(20)(21)(22)27,28,32,37) evaluated the occurrence of preeclampsia. Overall, there were 14,993 events in 504,700 pregnancies.…”

Section: Effect Of the Kidney Disease On Pregnancymentioning

confidence: 99%

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

Zhang

Hao

et al. 2015

Clinical Journal of the American Society of Nephrology

246

206

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Background and objectives We undertook a systematic review and meta-analysis of published cohort studies and case-control studies to estimate (1) the risk of pregnancy complications among patients with CKD versus those without CKD and (2) the risk of CKD progression among pregnant patients versus nonpregnant controls with CKD.Design, setting, participants, & measurements We searched electronic databases for studies published between 1946 and 2014, and we reviewed articles using validity criteria. Random-effects analytical methods were used.Results Twenty-three studies (14 with data for adverse pregnancy outcomes and 9 for renal outcomes) with 506,340 pregnancies were included. Pregnancy with CKD had greater odds of preeclampsia (odds ratio [OR], 10.36; 95% confidence interval [95% CI], 6.28 to 17.09), premature delivery (OR, 5.72; 95% CI, 3.26 to 10.03), small for gestational age/low birth weight (OR, 4.85; 95% CI, 3.03 to 7.76), cesarean section (OR, 2.67; 95% CI, 2.01 to 3.54), and failure of pregnancy (OR, 1.80; 95% CI, 1.03 to 3.13). Subgroup analysis showed that odds of preeclampsia (P,0.01) and premature delivery (P,0.01) were higher in women with nondiabetic nephropathy compared with diabetic nephropathy, and the odds of preeclampsia (P=0.01) and premature delivery (P,0.01) were higher in women with macroproteinuria compared with microproteinuria. The median for follow-up time for renal events was 5 years (interquartile range, 5-14.7 years). There were no significant differences in the occurrence of renal events between CKD pregnant women and those without pregnancy (OR, 0.96; 95% CI, 0.69 to 1.35). Subgroup analysis showed that publication year, sample size, follow-up years, type of primary disease, CKD classification, level of serum creatinine at baseline, proteinuria, and level of systolic BP did not modify the renal outcomes.Conclusions The risks of adverse maternal and fetal outcomes in pregnancy are higher for women with CKD versus pregnant women without CKD. However, pregnancy was not a risk factor for progression of renal disease in women with CKD before pregnancy.

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Section: Study Selection and General Informationmentioning

confidence: 99%

Section: Study Selection and General Informationmentioning

confidence: 99%

Section: Study Selection and General Informationmentioning

confidence: 99%

“…Nine studies (18)(19)(20)(21)(22)27,28,32,37) evaluated the occurrence of preeclampsia. Overall, there were 14,993 events in 504,700 pregnancies.…”

Section: Effect Of the Kidney Disease On Pregnancymentioning

confidence: 99%

See 2 more Smart Citations

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

Zhang

Hao

et al. 2015

Clinical Journal of the American Society of Nephrology

246

206

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“…ACOG -American College of Obstetricians and Gynecologists, AKF -acute kidney failure, PtU -proteinuria, wkweek, trim -trimester, DN -diabetic nephropathy, NR -not reported, HbA1c -glycated hemoglobin. References [64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79]. Sonographically normal kidneys, normal urine sediment, significant proteinuria and retinopathy -7.5±0.5 28±8…”

Section: Discussionmentioning

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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Implications for the Mother with Diabetes

Wender-Ożegowska

Sacks

2017

A Practical Manual of Diabetes in Pregnancy

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Effects of pregnancy on the onset and progression of diabetic nephropathy and of diabetic nephropathy on pregnancy outcomes

Cited by 35 publications

References 22 publications

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

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

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

Implications for the Mother with Diabetes

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