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Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding

Current Diabetes Reports volume 16, Article number: 12 (2016) Cite this article

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.

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Affiliations

  1. Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Lene Ringholm, Julie Agner Damm, Marianne Vestgaard, Peter Damm & Elisabeth R. Mathiesen

  2. Department of Endocrinology PE7562, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Lene Ringholm, Julie Agner Damm, Marianne Vestgaard & Elisabeth R. Mathiesen

  3. Steno Diabetes Center, Niels Steensens Vej 2, 2820, Gentofte, Denmark

    Lene Ringholm

  4. Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark

    Marianne Vestgaard, Peter Damm & Elisabeth R. Mathiesen

  5. Department of Obstetrics, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Peter Damm

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  1. Lene Ringholm
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Lene Ringholm, Julie Agner Damm, Marianne Vestgaard, Peter Damm and Elisabeth R. Mathiesen declare that they have no conflict of interest.

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This article is part of the Topical Collection on Microvascular Complications—Nephropathy

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Ringholm, L., Damm, J.A., Vestgaard, M. et al. Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding. Curr Diab Rep 16, 12 (2016). https://doi.org/10.1007/s11892-015-0705-3

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  • DOI: https://doi.org/10.1007/s11892-015-0705-3

Keywords

  • Diabetes
  • Nephropathy
  • Microalbuminuria
  • Antihypertensive treatment
  • Preeclampsia
  • Preterm delivery