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

Abstract

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.

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

“…An older study by Diamond et al reported that White's classification predicted perinatal mortality in diabetic pregnancies [11]. Fetal macrosomia in White's classes B to R and pre-eclampsia and SGA infants in class F may have contributed to the high emergency Caesarean section rates across White's classes [17]. The low vaginal delivery rates in classes R and F are in agreement with reports from other centres [13,22,26,27].…”

“…Gestational hypertension was defined similarly, but without the presence of proteinuria. Pre-eclampsia in patients with diabetic nephropathy was defined as worsening of hypertension (≥15 mmHg increase in systolic and/or diastolic blood pressure) with a proteinuria level of ≥5 g/24 h after 20 gestational weeks [17].…”

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

“…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.…”

“…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].…”

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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.

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