, Volume 38, Issue 2, pp 227–235 | Cite as

Pregnancies in women with diabetic nephropathy: long-term outcome for mother and child

  • R. Kimmerle
  • R. -P. Za\
  • S. Cupisti
  • T. Somville
  • R. Bender
  • B. Pawlowski
  • M. Berger


In order to improve the basis upon which to advise women with diabetic nephropathy about pregnancy, we studied the effect of diabetic nephropathy on the course of pregnancy, perinatal out-come, infant development and long-term outcome of the mothers. All pregnancies of women with diabetic nephropathy (defined as proteinuria >400 mg/day (n=26), creatinine clearance <80 ml/min and hypertension in the first trimester (n=10)) followed at our centre from 1982 to 1992 were identified (34 White class F and 2 White class T) and the women and their children re-examined in the spring 1993. From the first to the third trimester the percentage of women with proteinuria over 3 g/day increased from 14 to 53% and those treated with anti-hypertensive medication from 53 to 97%. There were no intrauterine or perinatal deaths, but one child died suddenly 4 weeks postpartum. Of 36 new-borns (gestational week at birth 36(3), birth weight 2384(834) g)), 11 were born before week 34 and 8 had respiratory distress syndrome. Renal function in the first trimester, diastolic blood pressure in the third trimester and an HbA1c above normal were predictive of gestational age at delivery and low birth weight (stepwise regression analysis). At follow-up of the children (n=35, age 4.5 (0.4–10) years) the majority (n=27) were normally developed but seven had psychomotor retardation (four of them major). One child had a severe motor retardation due to a congenital anomaly. At follow up, 21 of the 29 mothers had preserved renal function (creatinine 1.3 (0.8–4.3) mg/dl and 8 had developed end stage renal disease and required dialysis (2 of whom were White class T) within 3 (1–9) years postpartum. Of those, 4 women (3 White F and 1 White T) had died. Pregnancy did not seem to specifically accelerate the rate of decline of renal function. In women with diabetic nephropathy perinatal mortality can be prevented but perinatal and long-term infant morbidity remains elevated. Women with severely impaired renal function before pregnancy are at risk for serious morbidity when their children are still young. Improvement might be made if all women were to receive specialized care and counselling before, throughout and after pregnancy.

Key words

Diabetes mellitus nephropathy pregnancy 



end-stage renal disease


Denver developmental test


  1. 1.
    Dicker D, Feldberg D, Peleg D, Karp M, Goldman JA (1986) Pregnancy complicated by diabetic nephropathy. J Perinat Med 14: 299–307Google Scholar
  2. 2.
    Hare JW, White P (1977) Pregnancy in diabetic complicated by vascular diseases. Diabetes 26: 953–955Google Scholar
  3. 3.
    Nesler ChL, Sinclair SH, Schwartz SS, Gabbe SG (1985) Diabetic nephropathy in pregnancy. Clin Obstet Gyn 288: 528–535Google Scholar
  4. 4.
    Hayslett JP, Reece EA (1987) Effect of diabetic nephropathy on pregnancy. Am J Kidney Dis 9: 344–349Google Scholar
  5. 5.
    Jovanovic R, Jovanovic L (1984) Obstetric management when normoglycemia is maintained in diabetic pregnant women with vascular compromise. Am J Obstet Gynecol 149: 617–623Google Scholar
  6. 6.
    Kitzmüller JL, Brown ER, Phillippe M et al. (1981) Diabetic nephropathy and perinatal outcome. Am J Obstet Gynecol 141: 741–752Google Scholar
  7. 7.
    Reece EA, Coustan DR, Hayslett JP et al. (1988) Diabetic nephropathy: pregnancy performance and fetomaternal outcome. Am J Obstet Gynecol 159: 56–66Google Scholar
  8. 8.
    Mühlhauser I, Bruckner I, Berger M et al. (1987) Evaluation of an intensified insulin treatment and teaching program as routine management of type I (insulin-dependent) diabetes. The Bucharest-Düsseldorf Study. Diabetologia 30: 681–690Google Scholar
  9. 9.
    Cunningham GF, Lindheimer MD (1992) Hypertension in pregnancy. In: Desforges JF (ed) Current concepts. NEJM 326: 927–932Google Scholar
  10. 10.
    Redman CWG (1982) Controlled trials of treatment of hypertension during pregnancy. Obstet Gynecol Surv 37: 523–530Google Scholar
  11. 11.
    Largo P, Walli S (1980) Intrauterines und extrauterines Wachstum (Kinderkliniken Zürich und Winterthur. Helv Paed Acta 35: 419–425Google Scholar
  12. 12.
    Towen BCI (1979) Examination of the child with minor neurological dysfunction. In: Clinics in developmental medicine 71. Heinemann Medical Books, LondonGoogle Scholar
  13. 13.
    SAS/Stat guide for personal computers. 6th edition, 1987, SAS Institute Inc., Cary, NC, USAGoogle Scholar
  14. 14.
    Mogensen CE, Christensen CE, Christensen WJ et al. (1981) Renal function handling in normal hypertensive and diabetic men. Contrib Nephrol 24: 139–145Google Scholar
  15. 15.
    Katz AI, Davison JM, Hayslett JP, Sinson E, Lindheimer MD (1980) Pregnancy in women with kidney disease. Kidney Int 18: 192–206Google Scholar
  16. 16.
    Parving HH, Andersen AR, Smidt UM, Hommel E, Mathiesen ER, Svendsen PA (1987) Effect of antihypertensive treatment on kidney function in diabetic nephropathy. BMJ 294: 1443–1447Google Scholar
  17. 17.
    Soffronoff EC, Kaufmann BM, Connaughton JFF (1977) Intravascular volume determinations and fetal outcome in hypertensive diseases of pregnancy. Am J Obstet Gynecol 127: 4–9Google Scholar
  18. 18.
    Hanson U, Persson B, Thunell S (1990) Relationship between hemoglobin A1c in early type I (insulin-dependent) diabetic pregnancy and the occurrence of spontaneous abortion and fetal malformation in Sweden. Diabetologia 33: 100–104Google Scholar
  19. 19.
    McCormick MC, Brooks-Gunn J, Workman-Daneils K, Turner J, Peckham GJ (1992) The health and developmental status of very low-birth-weight children at school age. JAMA 267: 2204–2208Google Scholar
  20. 20.
    Michelsson K, Lindahl E, Parre M, Helenius M (1984) Nine-year follow-up of infants weighing 1500 g or less at birth. Acta Paediatr Scand 73: 835–841Google Scholar
  21. 21.
    Cummins M, Norrish A (1980) Follow-up of children of diabetic mothers. Arch Dis Child 55: 259–264Google Scholar
  22. 22.
    Persson B, Gentz J (1984) Follow-up of children of insulin-dependent and gestational diabetic mothers. Acta Paediatr Scand 73: 349–358Google Scholar
  23. 23.
    Bloch-Petersen M (1989) Status at 4–5 years in 90 children of insulin-dependent diabetic mothers. In: Stowers, Sutherland HW (eds) Carbohydrate metabolism in pregnancy and the newborn. Springer, N.Y. pp 354–361Google Scholar
  24. 24.
    Michelsson K, Noronen M (1983) Neurological, psychological and articulatory impairment in five-year-old children with birthweight of 2000 g or less. Eur J Pediatr 141: 96–100Google Scholar
  25. 25.
    Peterson MB, Pedersen SA, Greisen G, Pedersen JF, Molsted-Pedersen L (1984) Early growth delay in diabetic pregnancy: relation to psychomotor development at age 4. BMJ 283: 269–271Google Scholar
  26. 26.
    Ogburn PL, Kitzmiller JL, Hare JW (1986) Pregnancy following transplantation in class T diabetes mellitus. JAMA 255: 911–915Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • R. Kimmerle
    • 1
  • R. -P. Za\
    • 2
  • S. Cupisti
    • 1
  • T. Somville
    • 3
  • R. Bender
    • 1
  • B. Pawlowski
    • 4
  • M. Berger
    • 1
  1. 1.Department of Metabolic Diseases and Nutrition, WHO Collaborating Center for DiabetesHeinrich-Heine UniversityDüsseldorfGermany
  2. 2.Department of PediatricsHeinrich-Heine UniversityDüsseldorfGermany
  3. 3.Department of Obstetrics and GynecologyHeinrich-Heine UniversityDüsseldorfGermany
  4. 4.Diabetes Research InstituteDüsseldorfGermany

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