title: Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988-2011.
abstract: OBJECTIVE
  Our aim was to analyse possible changes in the glycaemic control, BP, markers of renal function, and obstetric and perinatal outcomes of parturients with diabetic nephropathy during 1988-2011.
  
  
  METHODS
  The most recent childbirth of 108 consecutive type 1 diabetes patients with diabetic nephropathy and a singleton pregnancy were studied. Two periods, 1988-1999 and 2000-2011, were compared.
  
  
  RESULTS
  The prepregnancy and the first trimester median HbA1c values persisted at high levels (8.2% [66 mmol/mol] vs 8.5% [69 mmol/mol], p = 0.16 and 8.3% [67 mmol/mol] vs 8.4% [68 mmol/mol], p = 0.67, respectively), but decreased by mid-pregnancy (6.7% [50 mmol/mol] vs 6.9% [52 mmol/mol], p = 0.11). Antihypertensive medication usage increased before pregnancy (34% vs 65%, p = 0.002) and in the second and third trimesters of pregnancy (25% vs 47%, p = 0.02, and 36% vs 60%, p = 0.01, respectively). BP exceeded 130/80 mmHg in 62% and 61% (p = 0.87) of patients in the first trimester, and in 95% and 93% (p = 0.69) in the third trimester, respectively. No changes were observed in the markers of renal function. Pre-eclampsia (52% vs 42%, p = 0.29) and preterm birth rates before 32 and 37 gestational weeks (14% vs 21%, p = 0.33, and 71% vs 77%, p = 0.49, respectively) remained high. The elective and emergency Caesarean section rates were 71% and 45% (p = 0.01) and 29% and 48% (p = 0.05), respectively. Neonatal intensive care unit admissions increased from 26% to 49% (p = 0.02).
  
  
  CONCLUSIONS
  Early pregnancy glycaemic control and hypertension management were suboptimal in both time periods. Pre-eclampsia and preterm delivery rates remained high in patients with diabetic nephropathy.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, P.O. Box 140, Haartmaninkatu 2, 00029, Helsinki, Finland, miira.klemetti@helsinki.fi.
authors.forename: Miira M
authors.initials: MM
authors.lastname: Klemetti
authors.forename: Hannele
authors.initials: H
authors.lastname: Laivuori
authors.forename: Minna
authors.initials: M
authors.lastname: Tikkanen
authors.forename: Mika
authors.initials: M
authors.lastname: Nuutila
authors.forename: Vilho
authors.initials: V
authors.lastname: Hiilesmaa
authors.forename: Kari
authors.initials: K
authors.lastname: Teramo
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002585:Cesarean Section; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007668:Kidney / Q000503:physiopathology; D010343:Patient Admission; D011225:Pre-Eclampsia / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D047928:Premature Birth / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human