Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome.
BACKGROUND
Diabetic nephropathy is associated with an increase in perinatal mortality and morbidity in uncontrolled pregnant patients. Recently angiotensin-converting enzyme inhibitor (ACE-I) was shown to improve the disease status in non-pregnant subjects. The purpose of this study was to examine the effect of prepregnancy treatment of insulin-dependent diabetes mellitus (IDDM) nephrotic women with captopril angiotensin converting enzyme inhibitor (ACE-1), on maternal renal function throughout pregnancy and on the fetomaternal outcome.


METHODS
Eight IDDM nephrotic patients planning pregnancy were treated with captopril for a minimum of 6 months prior to conception together with intensive insulin management. Conception was allowed when proteinuria was < 500 mg/day and euglycaemia was achieved. At conception captopril was discontinued.


RESULTS
At the beginning of captopril treatment, proteinuria was 1633 +/- 666 mg/day. At conception, proteinuria dropped to 273 +/- 146 mg/day (P = 0.0000) and increased gradually over the three trimesters to 593 +/- 515, 783 +/- 813, and 1000 +/- 1185 mg/day respectively (P = 0.2 between the trimesters); declining to 619 +/- 411 mg/day (P = 0.0002 vs conception) 3 months after delivery. Only in two patients (25%) did proteinuria exceed 1000 mg/day during pregnancy. There was no significant change in any of the other renal function tests: CCT, serum creatinine, uric acid, K+ and blood pressure. However, there were three cases of PET just prior to delivery. Maternal glycaemic control improved significantly prior to conception (P = 0.002) and remained euglycaemic (reflected by daily glucose profile, HbA1C and fructosamine) throughout gestation. Perinatal outcome was excellent.


CONCLUSIONS
Captopril treatment before pregnancy has a prolonged protective effect on maternal renal functions during pregnancy and results in a favourable maternal-fetal outcome.
Hod
M
M
Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah Tiqva, Israel.
van Dijk
D J
DJ
Karp
M
M
Weintraub
N
N
Rabinerson
D
D
Bar
J
J
Peled
Y
Y
Erman
A
A
Boner
G
G
Ovadia
J
J
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D011507:Proteinuria / Q000188:drug therapy / Q000378:metabolism; D012189:Retrospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril