Skip to main content

Pregnancy in women with diabetic nephropathy

Journal of Nephrology volume 32, pages 379–388 (2019)Cite this article

Abstract

The number of pregnancies in women with pregestational diabetes has been steadily increasing worldwide. These pregnancies are associated with an increased risk of a variety of complications, including miscarriages, congenital malformations, macrosomia, fetal growth restriction, preeclampsia, preterm delivery and stillbirth. In pregnant women with diabetic nephropathy it is important to evaluate both the effect of pregnancy on kidney function and the effect of kidney disease on pregnancy outcomes. Pregnant women with normal renal function and microalbuminuria have a low risk of loss of kidney function during pregnancy, while women with GFR < 60 ml/min and/or proteinuria ≥ 3 g/24 h at the beginning of pregnancy are at risk of permanent kidney damage. The risk of fetal and maternal complications is associated with the severity of chronic kidney disease and glycemic control. Advances in prenatal care have improved fetal and maternal outcomes and preconception counseling has become key for a successful pregnancy in all women with diabetes and especially in those with diabetes and chronic kidney disease.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Lawrence JM, Contreras R, Chen W, Sacks DA (2008) Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care 31:899–904. https://doi.org/10.2337/dc07-2345

    Article  PubMed  Google Scholar 

  2. Writing Group for the SEARCH for Diabetes in Youth Study Group, Dabelea D, Bell RA et al (2007) Incidence of diabetes in youth in the United States. JAMA 297:2716–2724. https://doi.org/10.1001/jama.297.24.2716

    Article  Google Scholar 

  3. Temple R, Murphy H (2010) Type 2 diabetes in pregnancy—an increasing problem. Best Pract Res Clin Endocrinol Metab 24:591–603. https://doi.org/10.1016/j.beem.2010.05.011

    Article  PubMed  Google Scholar 

  4. WHO Regional Office for Europe and the International Diabetes Federation (IDF), European Region (1990) Diabetes care and research in Europe: the Saint Vincent declaration. Diabet Med 7:360

    Article  Google Scholar 

  5. Kitzmiller JL, Wallerstein R, Correa A, Kwan S (2010) Preconception care for women with diabetes and prevention of major congenital malformations. Birth Defects Res Part A Clin Mol Teratol 88:791–803. https://doi.org/10.1002/bdra.20734

    CAS  Article  Google Scholar 

  6. Persson M, Norman M, Hanson U (2009) Obstetric and perinatal outcomes in type 1 diabetic pregnancies: a large, population-based study. Diabetes Care 32:2005–2009. https://doi.org/10.2337/dc09-0656

    Article  PubMed  PubMed Central  Google Scholar 

  7. Carr DB, Koontz GL, Gardella C et al (2006) Diabetic nephropathy in pregnancy: suboptimal hypertensive control associated with preterm delivery. Am J Hypertens 19:513–519. https://doi.org/10.1016/j.amjhyper.2005.12.010

    Article  PubMed  Google Scholar 

  8. Ekbom P, Damm P, Feldt-Rasmussen B et al (2001) Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care 24:1739–1744

    CAS  Article  Google Scholar 

  9. Nielsen LR, Damm P, Mathiesen ER (2009) Improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy: effect of intensified antihypertensive therapy? Diabetes Care 32:38–44. https://doi.org/10.2337/dc08-1526

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Kitzmiller JL, Montoro MN (2008) Diabetic nephropathic and pregnancy. In: Kitzmiller JL, Jovanovic L, Brown F, Coustan D, Reader DM (eds) Managing preexisting diabetes and pregnancy. American Diabetes Association, Arlington, pp 374–386

    Google Scholar 

  11. Gordon M, Landon MB, Samuels P et al (1996) Perinatal outcome and long-term follow-up associated with modern management of diabetic nephropathy. Obstet Gynecol 87:401–409

    CAS  Article  Google Scholar 

  12. Dunne FP, Chowdhury TA, Hartland A et al (1999) Pregnancy outcome in women with insulin-dependent diabetes mellitus complicated by nephropathy. QJM 92:451–454

    CAS  Article  Google Scholar 

  13. Biesenbach G, Stöger H, Zazgornik J (1992) Influence of pregnancy on progression of diabetic nephropathy and subsequent requirement of renal replacement therapy in female type I diabetic patients with impaired renal function. Nephrol Dial Transplant 7:105–109

    CAS  Article  Google Scholar 

  14. Kimmerle R, Zass RP, Cupisti S et al (1995) Pregnancies in women with diabetic nephropathy: long-term outcome for mother and child. Diabetologia 38:227–235

    CAS  Article  Google Scholar 

  15. Purdy LP, Hantsch CE, Molitch ME et al (1996) Effect of pregnancy on renal function in patients with moderate-to-severe diabetic renal insufficiency. Diabetes Care 19:1067–1074

    CAS  Article  Google Scholar 

  16. Kitzmiller JL, Brown ER, Phillippe M et al (1981) Diabetic nephropathy and perinatal outcome. Am J Obstet Gynecol 141:741–751

    CAS  Article  Google Scholar 

  17. Reece EA, Winn HN, Hayslett JP et al (1990) Does pregnancy alter the rate of progression of diabetic nephropathy? Am J Perinatol 7:193–197. https://doi.org/10.1055/s-2007-999479

    CAS  Article  PubMed  Google Scholar 

  18. Dicker D, Feldberg D, Peleg D et al (1986) Pregnancy complicated by diabetic nephropathy. J Perinat Med 14:299–307

    CAS  Article  Google Scholar 

  19. Grenfell A, Brudenell JM, Doddridge MC, Watkins PJ (1986) Pregnancy in diabetic women who have proteinuria. Q J Med 59:379–386

    CAS  PubMed  Google Scholar 

  20. Reece EA, Coustan DR, Hayslett JP et al (1988) Diabetic nephropathy: pregnancy performance and fetomaternal outcome. Am J Obstet Gynecol 159:56–66

    CAS  Article  Google Scholar 

  21. Mackie AD, Doddridge MC, Gamsu HR et al (1996) Outcome of pregnancy in patients with insulin-dependent diabetes mellitus and nephropathy with moderate renal impairment. Diabet Med 13:90–96. https://doi.org/10.1002/(SICI)1096-9136(199601)13:1<90::AID-DIA992>3.0.CO;2-M

    CAS  Article  PubMed  Google Scholar 

  22. Reece EA, Leguizamon G, Homko C (1998) Pregnancy performance and outcomes associated with diabetic nephropathy. Am J Perinatol 15:413–421. https://doi.org/10.1055/s-2007-993968

    CAS  Article  PubMed  Google Scholar 

  23. Miodovnik M, Rosenn BM, Khoury JC et al (1996) Does pregnancy increase the risk for development and progression of diabetic nephropathy? Am J Obstet Gynecol 174:1180–1189 (discussion 1189–91)

    CAS  Article  Google Scholar 

  24. Reece EA, Leguizamon G, Homko C (1998) Stringent controls in diabetic nephropathy associated with optimization of pregnancy outcomes. J Matern Fetal Med 7:213–216. https://doi.org/10.1002/(SICI)1520-6661(199807/08)7:4%3C213::AID-MFM11%3E3.0.CO;2-E

    CAS  Article  PubMed  Google Scholar 

  25. Brenner BM, Cooper ME, de Zeeuw D et al (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. NEJM 345:861–869. https://doi.org/10.1056/NEJMoa011161

    CAS  Article  PubMed  Google Scholar 

  26. Lewis EJ, Hunsicker LG, Clarke WR et al (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. NEJM 345:851–860. https://doi.org/10.1056/NEJMoa011303

    CAS  Article  PubMed  Google Scholar 

  27. Irfan S, Arain TM, Shaukat A, Shahid A (2004) Effect of pregnancy on diabetic nephropathy and retinopathy. J Coll Physicians Surg Pak 14:75–78

    PubMed  Google Scholar 

  28. Rossing K, Jacobsen P, Hommel E et al (2002) Pregnancy and progression of diabetic nephropathy. Diabetologia 45:36–41. https://doi.org/10.1007/s001250200003

    CAS  Article  PubMed  Google Scholar 

  29. Sandvik MK, Iversen BM, Irgens LM et al (2010) Are adverse pregnancy outcomes risk factors for development of end-stage renal disease in women with diabetes? Nephrol Dial Transplant 25:3600–3607. https://doi.org/10.1093/ndt/gfq275

    Article  PubMed  Google Scholar 

  30. Mathiesen ER, Ringholm L, Feldt-Rasmussen B et al (2012) Obstetric nephrology: pregnancy in women with diabetic nephropathy—the role of antihypertensive treatment. Clin J Am Soc Nephrol 7:2081–2088. https://doi.org/10.2215/CJN.00920112

    CAS  Article  PubMed  Google Scholar 

  31. Piccoli GB, Tavassoli E, Melluzza C et al (2013) Severe diabetic nephropathy in type 1 diabetes and pregnancy—a case series. Rev Diabet Stud 10:68–78. https://doi.org/10.1900/RDS.2013.10.68

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hod M, van Dijk DJ, Karp M et al (1995) Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome. Nephrol Dial Transplant 10:2328–2333

    CAS  Article  Google Scholar 

  33. Damm JA, Asbjörnsdóttir B, Callesen NF et al (2013) Diabetic nephropathy and microalbuminuria in pregnant women with type 1 and type 2 diabetes: prevalence, antihypertensive strategy, and pregnancy outcome. Diabetes Care 36:3489–3494. https://doi.org/10.2337/dc13-1031

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Vérier-Mine O, Chaturvedi N, Webb D, Fuller JH (2005) Is pregnancy a risk factor for microvascular complications? The EURODIAB prospective complications study. Diabet Med 22:1503–1509. https://doi.org/10.1111/j.1464-5491.2005.01682.x

    Article  PubMed  Google Scholar 

  35. American Diabetes Association (2004) Preconception care of women with diabetes. Diabetes Care 27(Suppl 1):S76–S78

    Google Scholar 

  36. Young EC, Pires MLE, Marques LPJ et al (2011) Effects of pregnancy on the onset and progression of diabetic nephropathy and of diabetic nephropathy on pregnancy outcomes. Diabetes Metab Syndr 5:137–142. https://doi.org/10.1016/j.dsx.2012.02.013

    Article  PubMed  Google Scholar 

  37. Nielsen LR, Müller C, Damm P, Mathiesen ER (2006) Reduced prevalence of early preterm delivery in women with type 1 diabetes and microalbuminuria—possible effect of early antihypertensive treatment during pregnancy. Diabet Med 23:426–431. https://doi.org/10.1111/j.1464-5491.2006.01831.x

    CAS  Article  PubMed  Google Scholar 

  38. Rosenn BM, Miodovnik J, Khoury H et al (1997) Outcome of pregnancy in women with diabetic nephropathy. Am J Obstet Gynecol 176:S179

    Article  Google Scholar 

  39. Bramham K (2017) Diabetic nephropathy and pregnancy. Semin Nephrol 37:362–369. https://doi.org/10.1016/j.semnephrol.2017.05.008

    Article  PubMed  Google Scholar 

  40. Ballas J, Moore TR, Ramos GA (2012) Management of diabetes in pregnancy. Curr Diabetes Rep 12:33–42. https://doi.org/10.1007/s11892-011-0249-0

    CAS  Article  Google Scholar 

  41. Sibai BM, Caritis S, Hauth J et al (2000) Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol 182:364–369

    CAS  Article  Google Scholar 

  42. Sibai BM (2000) Risk factors, pregnancy complications, and prevention of hypertensive disorders in women with pregravid diabetes mellitus. J Matern Fetal Med 9:62–65

    CAS  PubMed  Google Scholar 

  43. Klemetti MM, Laivuori H, Tikkanen M et al (2015) Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011. Diabetologia 58:678–686. https://doi.org/10.1007/s00125-014-3488-1

    CAS  Article  PubMed  Google Scholar 

  44. Leach L, Taylor A, Sciota F (2009) Vascular dysfunction in the diabetic placenta: causes and consequences. J Anat 215:69–76. https://doi.org/10.1111/j.1469-7580.2009.01098.x

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  45. Combs CA, Rosenn B, Kitzmiller JL et al (1993) Early-pregnancy proteinuria in diabetes related to preeclampsia. Obstet Gynecol 82:802–807

    CAS  PubMed  Google Scholar 

  46. How HY, Sibai B, Lindheimer M et al (2004) Is early-pregnancy proteinuria associated with an increased rate of preeclampsia in women with pregestational diabetes mellitus? Am J Obstet Gynecol 190:775–778. https://doi.org/10.1016/j.ajog.2003.11.031

    CAS  Article  PubMed  Google Scholar 

  47. Yogev Y, Chen R, Ben-Haroush A et al (2010) Maternal overweight and pregnancy outcome in women with type-1 diabetes mellitus and different degrees of nephropathy. J Matern Fetal Neonatal Med 23:999–1003. https://doi.org/10.3109/14767050903544744

    Article  PubMed  Google Scholar 

  48. Clausen TD, Mathiesen E, Ekbom P et al (2005) Poor pregnancy outcome in women with type 2 diabetes. Diabetes Care 28:323–328

    Article  Google Scholar 

  49. Boulot P, Chabbert-Buffet N, d’Ercole C et al (2003) French multicentric survey of outcome of pregnancy in women with pregestational diabetes. Diabetes Care 26:2990–2993

    Article  Google Scholar 

  50. Lapolla A, Dalfrà MG, Di Cianni G et al (2008) A multicenter Italian study on pregnancy outcome in women with diabetes. Nutr Metab Cardiovasc Dis 18:291–297. https://doi.org/10.1016/j.numecd.2006.12.001

    Article  PubMed  Google Scholar 

  51. Dunne F, Brydon P, Smith K, Gee H (2003) Pregnancy in women with type 2 diabetes: 12 years outcome data 1990–2002. Diabet Med 20:734–738

    CAS  Article  Google Scholar 

  52. Lapolla A, Dalfrà MG, Fedele D (2008) Pregnancy complicated by type 2 diabetes: an emerging problem. Diabetes Res Clin Pract 80:2–7. https://doi.org/10.1016/j.diabres.2007.11.009

    CAS  Article  PubMed  Google Scholar 

  53. Hillman N, Herranz L, Vaquero PM et al (2006) Is pregnancy outcome worse in type 2 than in type 1 diabetic women? Diabetes Care 29:2557–2558. https://doi.org/10.2337/dc06-0680

    Article  PubMed  Google Scholar 

  54. Macintosh MCM, Fleming KM, Bailey JA et al (2006) Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ 333:177. https://doi.org/10.1136/bmj.38856.692986.AE

    Article  PubMed  PubMed Central  Google Scholar 

  55. Roland JM, Murphy HR, Ball V et al (2005) The pregnancies of women with type 2 diabetes: poor outcomes but opportunities for improvement. Diabet Med 22:1774–1777. https://doi.org/10.1111/j.1464-5491.2005.01784.x

    CAS  Article  PubMed  Google Scholar 

  56. Temple R (2011) Preconception care for women with diabetes: is it effective and who should provide it? Best Pract Res Clin Obstet Gynaecol 25:3–14. https://doi.org/10.1016/j.bpobgyn.2010.10.001

    Article  PubMed  Google Scholar 

  57. Biesenbach G, Zazgornik J, Stöger H et al (1994) Abnormal increases in urinary albumin excretion during pregnancy in IDDM women with pre-existing microalbuminuria. Diabetologia 37:905–910

    CAS  Article  Google Scholar 

  58. Li D-K, Yang C, Andrade S et al (2011) Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study. BMJ 343:d5931–d5931. https://doi.org/10.1136/bmj.d5931

    Article  PubMed  PubMed Central  Google Scholar 

  59. The American Diabetes Association (ADA) (2018) Management of diabetes in pregnancy. Stand Med Care Diabetes Care 41:S137–S143

    Article  Google Scholar 

  60. Società Italiana di Diabetologia (SID) and Associazione Medici Diabetologi (AMD) (2014) Standard italiani per la cura del diabete mellito. https://www.standarditaliani.it

Download references

Author information

Affiliations

  1. OU Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy

    Donatella Spotti

Authors
  1. Donatella Spotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donatella Spotti.

Ethics declarations

Conflict of interest

The author declares that she has no conflict of interest as for the topic of this review article.

Ethical statement

The author declares that the review article is in compliance with the ethical standards.

Research involving human participants

Not applicable. This review article does not contain any study with human participants performed by the author.

Informed consent

Not applicable.

Additional information

This article is part of the topical collection on Obstetric Nephrology.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Spotti, D. Pregnancy in women with diabetic nephropathy. J Nephrol 32, 379–388 (2019). https://doi.org/10.1007/s40620-018-0553-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40620-018-0553-8

Keywords

  • Pregestational diabetes
  • Pregnancy
  • Diabetic nephropathy