Effect of pregnancy on diabetic nephropathy and retinopathy.
OBJECTIVE
To determine whether pregnancy worsens renal function in women with diabetic nephropathy and the effect of pregnancy on diabetic retinopathy.


METHODS
Cross-sectional analytical study.


METHODS
The study was conducted in OPD, Bahawal Victoria Hospital, Bahawalpur from September 1997 to June 2003.


METHODS
Thirty-five patients (aged 20-36 years ) identified with diabetic nephropathy and moderate to severe renal dysfunction(creatinine [Cr] > 1.4 mg/dl) at pregnancy onset by retrospective chart review. Alterations in glomerular filtration rate (GFR) were estimated. An equal number of non-pregnant premenopausal type I diabetic women with similar degrees of renal dysfunction served as controls for non-pregnant rate of decline of renal function and potential contributing factors. Student's t-test and repeated measures analysis of variance were analyzed.


RESULTS
Mean serum Cr rose from 1.8 mg/dl prepregnancy to 2.5 mg/dl in the third trimester. Renal function was stable in 27%, showed transient worsening in pregnancy in 27%, and demonstrated a permanent decline in 45%. Proteinuria increased in pregnancy in 79%. Exacerbation of hypertension or pre-eclampsia occurred in 73% and 71% of these showed acceleration of disease during the pregnancy. All the patients had diabetic retinopathy, though proliferative retinopathy was diagnosed and treated in only 54.5.% prepregnancy. The retinopathy progressed, requiring laser therapy, in 45.4%. Macular edema was noted in 6 of the patients. Other diabetic complications included peripheral and autonomic neuropathy in 8 patients.


CONCLUSIONS
Pregnancy induced progression is seen in the decline of renal functions. Patients with diabetic nephropathy were found to have a > 40% chance of accelerated progression of their disease as a result of pregnancy. Forty-five percent of the patients had permanent decline in GFR in association with pregnancy.
Irfan
Shahid
S
Medical Unit III, Bahawal Victoria Hospital, Bahawalpur.
Arain
Tariq Mahmud
TM
Shaukat
Asma
A
Shahid
Amna
A
D000328:Adult; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000097:blood / Q000469:parasitology / Q000473:pathology; D003930:Diabetic Retinopathy / Q000097:blood / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D016014:Linear Models; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology
D003404:Creatinine