Perinatal outcome and long-term follow-up associated with modern management of diabetic nephropathy.
OBJECTIVE
To determine outcomes in pregnancies complicated by class F diabetes mellitus cared for at a single center, and to assess renal function in these women.


METHODS
A retrospective review (1988-1994) of all pregnant women with class F diabetes was performed, as well as an evaluation of current renal function.


RESULTS
Forty-six pregnancies in 45 women reached a mean (+/- standard deviation) gestational age of 35.8 +/- 2.3 weeks, with a mean birth weight of 2623 +/- 818 g. No deliveries occurred before 30 weeks and 39 (84%) were at least 34 weeks. Perinatal survival was 100%. Women with initial serum creatinine exceeding 1.5 mg/dL or more than 3 g/24 hours proteinuria had an increased risk of early delivery, lower birth weight, preeclampsia, and cesarean delivery. Twenty-four individuals (53%) developed preeclampsia and seven met criteria for severe preeclampsia. By the third trimester, 26 women(58%) had greater than a 1 g/24 hour increase in proteinuria and 16 (36%) demonstrated more than a 15% fall in creatinine clearance. Follow-up was obtained in 34 subjects with a mean duration of 2.8 years. Individuals with initial creatinine clearance greater than 90 mL/minute and less than 1 g of protein per 24 hours had less loss of renal function at follow-up, as measured by creatinine clearance. At follow-up, mean protein excretion had decreased 1.9 g/24 hours from third-trimester values, but eight women (24%) maintained protein excretion exceeding 3 g/24 hours.


CONCLUSIONS
Modern management of class F patients can result in good perinatal outcomes. Renal function studies early in pregnancy can be used to define the risk of perinatal morbidity and long-term progression of renal disease.
Gordon
M
M
Department of Obstetrics and Gynecology, the Ohio State University College of Medicine, Columbus, OH, USA.
Landon
M B
MB
Samuels
P
P
Hissrich
S
S
Gabbe
S G
SG
D000328:Adult; D000704:Analysis of Variance; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000628:therapy; D003928:Diabetic Nephropathies / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016014:Linear Models; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000503:physiopathology / Q000628:therapy; D011507:Proteinuria; D012189:Retrospective Studies; D016896:Treatment Outcome
D003404:Creatinine