Clinical value of detecting microalbuminuria as a risk factor for pregnancy-induced hypertension in insulin-treated diabetic pregnancies.
OBJECTIVE
We evaluated the role of clinical non-overt stage III diabetic nephropathy concerning the development of more frequent hypertensive complications during pregnancies of women requiring insulin.


METHODS
122 unselected pregnant women treated with insulin were enrolled in the study, of whom 56 were type-1 diabetic patients and 66 patients had gestational diabetes. In 24-h urine samples, excretion rates of albumin (UAE) and beta(2)-microglobulin were determined by nephelometric analysis and a radioimmunoassay, respectively. These parameters were also measured in the serum as well as HbA(1c), fructosamine and daily blood glucose profiles.


RESULTS
Sixteen (15.7%) women had an elevated UAE (>30 mg/24 h), of whom three had macroalbuminuria (UAE>300 mg/24 h). Thirteen (12.7%) insulin-treated women showed microalbuminuria during pregnancy, eight with type-1 diabetes and five with gestational diabetes requiring insulin. In the entire group hypertension was observed in seven (6.9%) women of whom six had microalbuminuria. The sensitivity and specificity were 85.7% and 92.6%, respectively. The positive predictive value reached 46.2%, whereas the negative predictive value was 98.9%.


CONCLUSIONS
Measurement of UAE in diabetic pregnancies seems to be an useful additional parameter for risk evaluation of hypertensive disorders.
Schröder
W
W
Department of Gynaecology and Obstetrics, Städt. Kliniken Offenbach, Academic Affiliation of University Hospital Frankfurt, Offenbach, Germany.
Heyl
W
W
Hill-Grasshoff
B
B
Rath
W
W
D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000652:urine*; D001786:Blood Glucose / Q000032:analysis; D003928:Diabetic Nephropathies / Q000150:complications* / Q000652:urine; D005260:Female; D019270:Fructosamine / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007328:Insulin / Q000627:therapeutic use*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology*; D011254:Pregnancy in Diabetics / Q000150:complications* / Q000188:drug therapy; D012307:Risk Factors
D001786:Blood Glucose; D019270:Fructosamine; D006442:Glycated Hemoglobin; D007328:Insulin