title: Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding.
abstract: In women with preexisting diabetes and nephropathy or microalbuminuria, it is important to deliver careful preconception counselling to assess the risk for the mother and the foetus, for optimizing glycaemic status and to adjust medical treatment. If serum creatinine is normal in early pregnancy, kidney function is often preserved during pregnancy, but complications such as severe preeclampsia and preterm delivery are still common. Perinatal mortality is now comparable with that in women with diabetes and normal kidney function. Besides strict glycaemic control before and during pregnancy, early and intensive antihypertensive treatment is important to optimize pregnancy outcomes. Methyldopa, labetalol, nifedipine and diltiazem are considered safe, whereas angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers should be stopped before or at confirmation of pregnancy. Supplementation with folic acid in early pregnancy and low-dose aspirin from 10 to 12 weeks reduces the risk of adverse pregnancy outcomes. During breastfeeding, several ACE inhibitors are considered safe.
authors.affiliation: Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. enel@dadlnet.dk.|Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. enel@dadlnet.dk.|Steno Diabetes Center, Niels Steensens Vej 2, 2820, Gentofte, Denmark. enel@dadlnet.dk.
authors.forename: Lene
authors.initials: L
authors.lastname: Ringholm
authors.affiliation: Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. julie.agner.damm@gmail.com.|Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. julie.agner.damm@gmail.com.
authors.forename: Julie Agner
authors.initials: JA
authors.lastname: Damm
authors.affiliation: Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. marianne_vestgaard@hotmail.com.|Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. marianne_vestgaard@hotmail.com.|Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark. marianne_vestgaard@hotmail.com.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vestgaard
authors.affiliation: Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. pdamm@dadlnet.dk.|Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark. pdamm@dadlnet.dk.|Department of Obstetrics, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. pdamm@dadlnet.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Damm
authors.affiliation: Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. elisabeth.reinhardt.mathiesen@regionh.dk.|Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. elisabeth.reinhardt.mathiesen@regionh.dk.|Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark. elisabeth.reinhardt.mathiesen@regionh.dk.
authors.forename: Elisabeth R
authors.initials: ER
authors.lastname: Mathiesen
mesh_terms: D001942:Breast Feeding; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D009389:Neovascularization, Pathologic; D011225:Pre-Eclampsia; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome
keywords: Antihypertensive treatment; Diabetes; Microalbuminuria; Nephropathy; Preeclampsia; Preterm delivery