Pregnancy outcome and progression of diabetic nephropathy. What's next?
OBJECTIVE
The first objective was to assess the association of renal function with maternal and fetal pregnancy outcome in women with diabetic nephropathy. The second objective was to examine the feasibility of a multicenter surveillance program to determine the rates of maternal and fetal pregnancy complications in women with diabetic nephropathy, and to study the effect of pregnancy on the natural history of diabetic renal disease.


METHODS
In order to address the first objective, we analyzed data from women with type 1 diabetes and nephropathy enrolled in the Diabetes in Pregnancy Program at our institution. Women were assigned to one of three groups according to enrolment serum creatinine concentration: < or = 1.0 mg/dl, > 1.0 to 1.5 mg/dl and > 1.5 mg/dl. A pilot surveillance program at six centers included women experiencing pregnancy complicated by diabetic nephropathy. In both studies, medical and obstetric history, and maternal and neonatal outcomes, were recorded. Statistical analysis included chi2, logistic regression and analysis of variance.


RESULTS
There were 72 pregnancies in 58 women with diabetic nephropathy who enrolled in the pregnancy program. High serum creatinine concentration at enrolment was associated with delivery before 32 weeks' gestation, very low birth weight and increased incidence of neonatal hypoglycemia, independent of quantity of total urinary protein excretion and glycemic control in any trimester. To date, pilot surveillance data have been obtained from six centers on 16 women. Serum creatinine concentrations ranged from 0.4 to 1.1 mg/dl and creatinine clearance from 32 to 317 m/min. Gestational age at delivery ranged from 22 to 39 weeks.


CONCLUSIONS
High serum creatinine concentration at enrolment is a risk factor for adverse maternal and neonatal outcome, independent of quantity of total urinary protein excretion and glycemic control during any trimester. A multicenter surveillance program is needed, in order to study less frequent maternal and neonatal outcomes as well as the long-term effects of pregnancy on the natural course of diabetic renal disease.
Khoury
J C
JC
Department of Environmental Health, University of Cincinnati College of Medicine, Ohio 45267-0056, USA.
Miodovnik
M
M
LeMasters
G
G
Sibai
B
B
D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D010865:Pilot Projects; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D014553:Urinary Tract Physiological Phenomena / Q000187:drug effects
D015415:Biomarkers; D007004:Hypoglycemic Agents; D007328:Insulin; D003404:Creatinine