Skip to main content

Abstract

The potential problems of diabetic nephropathy and pregnancy require the anticipation of preconception care. Every clinician who cares for adolescent and adult diabetic women has an obligation to recognise that these women may become pregnant, that most of the risks to mother and offspring are related to poor glycemic control, and that the risks may be reduced through special programs that achieve meticulous metabolic balance before conception and throughout pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Kitzmiller JL, Buchanan TA, Kjos S, et al. Pre-conception care of diabetes, congenital malformations, and spontaneous abortions. Technical review. Diab Care 1996; 19: 514–541

    CAS  Google Scholar 

  2. Fuhrmann K, Reiher H, Semmler K, Glockner E. The effect of intensified conventional insulin therapy before and during pregnancy on the malformation rate in offspring of diabetic mothers. Exp Clin Endocrinol 1984; 83: 173–177.

    Article  PubMed  CAS  Google Scholar 

  3. Damm P, Molsted-Pedersen L. Significant decrease in congenital malformations in newborn infants of an unselected population of diabetic women. Am J Obst Gynec 1989; 161: 1163–1167

    Article  CAS  Google Scholar 

  4. Kitzmiller JL, Gavin LA, Gin GD, et al. Preconception care of diabetes. Glycemic control prevents congenital anomalies. JAMA 1991; 265: 731–736.

    Article  PubMed  CAS  Google Scholar 

  5. StJames PJ, Younger MD, Hamilton BD, Waisbren SE. Unplanned pregnancies in diabetic women. Diab Care 1993; 16: 1572–1578

    Article  CAS  Google Scholar 

  6. Kjos SL. Contraception in diabetic women. Obst Gynecol Clinics North Amer 1996; 23: 243–257

    Article  CAS  Google Scholar 

  7. Janz NK, Herman WH, Becker MP, et al. Diabetes and pregnancy: factors associated with seeking pre-conception care. Diab Care 1995; 18: 157–165.

    Article  CAS  Google Scholar 

  8. oling E, Beyer CS. Why don’t women with diabetes plan their pregnancies? Diab 1997; 46,Suppl 1: 15A.

    Google Scholar 

  9. Mogensen CE, Chachati A, Christensen CK et al. Microalbuminuria: an early marker for renal involvement in diabetes. Uremia Invest 1985–86;9: 85–95.

    Google Scholar 

  10. Combs CA, Wheeler BC, Kitzmiller JL. Urinary protein/creatinine ratio before and during pregnancy in women with diabetes mellitus. Am J Obstet Gynecol 1991; 165: 920–923.

    Article  PubMed  CAS  Google Scholar 

  11. Stehouwer CDA, Fischer HRA, Hackeng WHL, et al. Diurnal variation in urinary protein excretion in diabetic nephropathy. Nephrol Dial Transplant 1991; 6: 238–243.

    Article  PubMed  CAS  Google Scholar 

  12. Quadri KHM, Bernardini J, Greenberg MD, et al. Assessment of renal function during pregnancy using a random urine protein to creatinine ratio and Cockcroft-Gault ratio. Amer J Kid Dis 1994; 24: 416–420.

    CAS  Google Scholar 

  13. Piper JM, Ray WA, Rosa FW. Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors. Obst Gynec 1992; 80: 429–432.

    CAS  Google Scholar 

  14. Rosa FW, Bosco LA, Graham CF, et al. Neonatal anuria with maternal angiotensin-converting enzyme inhibition. Obst Gynec 1989; 74:371.

    CAS  Google Scholar 

  15. Hanssens M, Keirse MJNC, Vankelecom F, Van Assche FA. Fetal and neonatal effects of treatment with angiotensin-converting enzyme inhibitors in pregnancy. Obstet Gynecol 1991; 78: 128–135.

    PubMed  CAS  Google Scholar 

  16. Hod M, van Dijk DJ, Karp M, et al. Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on maternal outcome. Neph Dial Transpl 1995; 10: 2328–2333

    CAS  Google Scholar 

  17. Jovanovic R, Jovanovic L. Obstetric management when normoglycemia is maintained in diabetic pregnant women with vascular compromise. Am J Obstet Gynecol 1984; 149: 617–623.

    PubMed  CAS  Google Scholar 

  18. Magee LA, Conover B, Schick B, et al. Exposure to calcium channel blockers in human pregnancy: a prospective, controlled, multicentre cohort study. Teratol 1994; 49: 372–376.

    Google Scholar 

  19. Brinchmann-Hansen O, Dahl-J□rgensen K, Hanssen KF, et al. Effects of intensified insulin treatment on various lesions of diabetic retinopathy. Am J Ophthalmol 1985; 100: 644–649

    PubMed  CAS  Google Scholar 

  20. Klein BEK, Moss SE, Klein R. Effect of pregnancy on progression of diabetic retinopathy. Diab Care 1990;13:34–40.

    Article  CAS  Google Scholar 

  21. Chew EY, Mills JL, Metzger BE, et al. The diabetes and early pregnancy study. Metabolic control and progression of retinopathy. Diab Care 1995; 18: 631–637.

    CAS  Google Scholar 

  22. Jensen T, Borch-Johnson K, Kofoed-Enevoldsen A, Deckert T. Coronary heart disease in young type 1 (insulin dependent) diabetic patients with and without diabetic nephropathy: incidence and risk factors. Diabetologia 1987; 30: 144–148.

    Article  PubMed  CAS  Google Scholar 

  23. Reece EA, Egan JFX, Coustan DR, et al. Coronary artery disease in diabetic pregnancies. Amer J Obst Gynec 1986; 154: 150–151.

    CAS  Google Scholar 

  24. Manske CL, Thomas W, Wang Y, Wilson RF. Screening diabetic transplant candidates for coronary artery disease: identification of a low risk subgroup. Kidney Intl 1993; 44: 617–621

    Article  CAS  Google Scholar 

  25. Salomon NW, Page US, Okies JE, et al. Diabetes mellitus and coronary artery bypass: short term risk and long term prognosis. J Thorac Cardiovasc Surg 1983; 85: 264–268.

    PubMed  CAS  Google Scholar 

  26. Krutzen E, Olofsson P, Back SE, Nilsson-Ehle P. Glomerular filtration rate in pregnancy: a study in normal subjects and in patients with hypertension, preeclampsia and diabetes. Scand J Clin Lab Invest 1992; 52: 387–392.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  29. Biesenbach G, Grafinger P, Stoger H, Zasgornik J. How pregnancy influences renal function in nephropathic type 1 diabetic women depends on their pre-conception creatinine clearance. J Nephrol. 1999; 12: 41–46.

    PubMed  CAS  Google Scholar 

  30. Christensen T, Klebe JG, Berthelsen V, Hansen HE. Changes in renal volume during normal pregnancy. Acta Obst Gynec Scand 1989; 68: 541–543.

    CAS  Google Scholar 

  31. Lauszas FF, Klebe JG, Rasmussen OW, et al. Renal growth during pregnancy in insulin-dependent diabetic women. A prospective study of renal volume and clinical variables. Acta Diabetol 1995; 32: 225–229.

    Article  Google Scholar 

  32. Pedersen EB, Rasmussen AB, Johannsen P, et al. Urinary excretion of albumin, beta-2-microglobulin and light chains in preeclampsia, essential hypertension in pregnancy, and normotensive pregnant and non-pregnant control subjects. Scand J Clin Lab Investig 1981; 41: 777–784.

    Article  Google Scholar 

  33. Lopez-Espinoza I, Humphreys S, Redman CWG. Urinary albumin excretion in pregnancy. Br J Obst Gynec 1986; 93: 176–181.

    Article  CAS  Google Scholar 

  34. Wright A, Steele P, Bennett JR, et al. The urinary excretion of albumin in normal pregnancy. Br J Obstet Gynaecol 1987; 94: 408–412.

    Article  PubMed  CAS  Google Scholar 

  35. Cheung CK, Lao T, Swaminathan R. Urinary excretion of some proteins and enzymes during normal pregnancy. Clin Chem 1989; 35: 1978–1980.

    PubMed  CAS  Google Scholar 

  36. Higby K, Suiter CR, Phelps JY, et al. Normal values of urinary albumin and total protein excretion during pregnancy. Am J Obst Gynec 1994; 171: 984–989.

    Article  CAS  Google Scholar 

  37. Roberts M, Lindheimer MD, Davison JM. Altered glomerular permselectivity to neutral dextrans and heteroporous membrane modeling in human pregnancy. Am J Physiol 1996; 270: F338–F343.

    PubMed  CAS  Google Scholar 

  38. McCance DR, Traub AI, Harley JMG, et al. Urinary albumin excretion in diabetic pregnancy. Diabetologia 1989; 32: 236–239.

    Article  PubMed  CAS  Google Scholar 

  39. Biesenbach G, Zasgornik J. Incidence of transient nephrotic syndrome during pregnancy in diabetic women with and without pre-existing microalbuminuria. Br Med J 1989; 299: 366–367.

    Article  CAS  Google Scholar 

  40. MacRury SM, Pinion S, Quin JD, et al. Blood rheology and albumin excretion in diabetic pregnancy. Diabetic Med 1995; 12: 51–55.

    Article  PubMed  CAS  Google Scholar 

  41. Diglas J, Bali C, Simon C, Strassegger-Bohm, Irsigler K. [Renal excretion of albumin during pregnancy and after birth in type 1 diabetic patients compared to metabolically healthy women]. [article in German]. Acta Med Austriaca 1997; 24: 170–174.

    PubMed  CAS  Google Scholar 

  42. Winocour PH, Taylor RJ. Early alterations of renal function in insulin-dependent diabetic pregnancies and their importance in predicting preeclamptic toxaemia. Diabetes Res 1989; 10: 159–164.

    PubMed  CAS  Google Scholar 

  43. Biesenbach G, Zasgornik J, Stoger H, et al. Abnormal increases in urinary albumin excretion during pregnancy in IDDM women with preexisting albuminuria. Diabetologia 1994; 37: 905–910.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  45. Bar J, Hod M, Erman A, et al. Microalbuminuria as an early predictor of hypertensive complications in pregnant women at high risk. Am J Kidney Dis 1996; 28: 220–225.

    Article  PubMed  CAS  Google Scholar 

  46. Das V, Bhargava T, Das SK, Pandey S. Microalbuminuria: a predictor of pregnancy-induced hypertension. Br J Obst Gynec 1996; 103: 928–930.

    Article  CAS  Google Scholar 

  47. Ekbom P and the Copenhagen Pre-eclampsia in Diabetic Pregnancy Study Group. Pre-pregnancy microalbuminuria predicts pre-eclampsia in insulin-dependent diabetes mellitus. Lancet 1999; 353:377.

    Article  PubMed  CAS  Google Scholar 

  48. Konstantin-Hansen KF, Hesseldahl H, Moller Pedersen S. Microalbuminuria as a predictor of preeclampsia. Acta Obst Gynec Scand 1992; 71: 341–346.

    Google Scholar 

  49. Mogensen CE, Klebe JG. Microalbuminuria and diabetic pregnancy, in Mogensen, CE (ed.) The Kidney and Hypertension in Diabetes Mellitus. Fourth Edition. 1998 by Kluwer Academic Publishers, Boston/Dordrecht/London, 455–462

    Google Scholar 

  50. Dicker D, Feldberg, Peleg, et al. Pregnancy complicated by diabetic nephropathy. J Perin Med 1986; 14: 299–306.

    Article  CAS  Google Scholar 

  51. Grenfell A, Brudenell JM, Doddridge MC, Watkins PJ. Pregnancy in diabetic women who have proteinuria. Quart J Med 1986; 59: 379–386

    PubMed  CAS  Google Scholar 

  52. Biesenbach G, Stoger H, Zasgornik J. 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 1992; 7: 105–109.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  54. Gordon M, Landon MB, Samuels P, et al. Perinatal outcome and long-term follow-associated with modern managment of diabetic nephropathy. Obstet Gynecol 1996; 87: 401–409.

    Article  PubMed  CAS  Google Scholar 

  55. Miodovnik M, Rosenn BM, Khoury JC, et al. Does pregnancy increase the risk for development and progression of diabetic nephropathy? Am J Obst Gynecol 1996:174:1180–1191.

    Article  CAS  Google Scholar 

  56. Purdy LP, Hantsch CE, Molitsch ME, et al. Effect of pregnancy on renal function in patients with moderate-to-severe diabetic renal insufficiency. Diab Care 1996; 19: 1067–1074

    Article  CAS  Google Scholar 

  57. Mackie ADR, Doddridge MC, Gamsu HR, et al. Outcome of pregnancy in patients with insulin-dependent diabetes mellitus and nephropathy with moderate renal impairment. Diabetic Med 1996; 13: 90–96.

    Article  PubMed  CAS  Google Scholar 

  58. Reece EA, Leguizamon G, Homko C. Stringent controls in diabetic nephropathy associated with optimization of pregnancy outcomes. J Mat-Fetal Med 1998; 7: 213–216.

    Article  CAS  Google Scholar 

  59. Yasin SY, Bey Doun SN. Hemodialysis in pregnancy. Obst Gynec Surv 1988; 43: 655–668.

    Article  CAS  Google Scholar 

  60. Hou S. Pregnancy in women requiring dialysis for renal failure. Am J Kidney Dis 1987; 9: 368–375.

    PubMed  CAS  Google Scholar 

  61. Reece EA, Winn HN, Hayslett JP, et al. Does pregnancy alter the rate of progression of diabetic nephropathy? Am J Perinat 1990; 7: 193–197.

    Article  CAS  Google Scholar 

  62. Mogensen CE. Progression of nephropathy in long-term diabetics with proteinuria and effect of initial antihypertensive treatment. Scand J Clin Lab Invest 1976; 36: 383–387.

    Article  PubMed  CAS  Google Scholar 

  63. Chaturvedi N, Stephenson JM, Fuller JH, et al. The relationship between pregnancy and long-term maternal complications in the EURODIAB IDDM complications study. Diabetic Med 1995; 12: 494–499.

    Article  PubMed  CAS  Google Scholar 

  64. Kaaja R, Sjoberg L, Hellstedt T, et al. Long-term effects of pregnancy on diabetic complications. Diabetic Med 1996; 13: 165–169.

    Article  PubMed  CAS  Google Scholar 

  65. Kitzmiller JL. Sweet success with diabetes. The development of insulin therapy and glycemic control for pregnancy. Diab Care 1993; 16(Suppl 3): 107–121.

    Google Scholar 

  66. Holley JL, Bernardini J, Quadri KHM, et al. Pregnancy outcomes in a prospective matched control study of pregnancy and renal disease. Clinical Nephrol 1996; 45: 77–82.

    CAS  Google Scholar 

  67. Greene MF, Hare JW, Krache M, et al. Prematurity among insulin-requiring diabetic gravid women. Am J Obst Gynec 1989; 161: 106–111.

    Article  CAS  Google Scholar 

  68. Garner PR, D’Alton ME, Dudley DK, et al. Preeclampsia in diabetic pregnancies. Am J Obst Gynec 1990; 163: 505–508.

    Article  CAS  Google Scholar 

  69. Hopp H, Vollert W, Ebert A, Weitzel H, Glockner E, Jahrig D. [Diabetic retinopathy and nephropathy û complications during pregnancy and delivery]. [article in German]. Geburtsh. U. Frauenheilk. 1995; 55: 275–279.

    Article  CAS  Google Scholar 

  70. Yankowitz J, Piraino B, Laifer A, et al. Use of erythroitin in pregnancies complicated by severe anemia of renal failure. Obst Gynecol. 1992; 80: 485–488.

    CAS  Google Scholar 

  71. Hou S, Orlowski J, Pahl M, et al. Pregnancy in women with end-stage renal disease: treatment of anemia and premature labor. Am J Kidney Dis 1993; 21: 16–22.

    PubMed  CAS  Google Scholar 

  72. Braga J, Marques R, Branco A, et al. Maternal and perinatal implications of the use of human recombinant erythroitin. Acta Obst Gynecol Scand 1996; 75: 449–453.

    Article  CAS  Google Scholar 

  73. Salvesen DR, Higueras MT, Brudenell M, et al. Doppler velocimetry and fetal heart studies in nephropathic diabetics. Am J Obst Gynec 1992; 167: 1297–1303.

    Article  CAS  Google Scholar 

  74. Ogburn PL, Jr, Kitzmiller JL, Hare JW, et al. Pregnancy following renal transplantation in class T diabetes mellitus. JAMA 1986; 225: 911–915.

    Article  Google Scholar 

  75. Armenti VT, McGrory CH, Cater J, et al. The national transplantation registry: comparison between pregnancy outcomes in diabetic cyclosporine-treated female kidney recipients and CyA-treated female pancreas-kidney recipients. Transpl Proc 1997; 29: 669–670.

    Article  CAS  Google Scholar 

  76. Skannal DG, Miodovnik M, Dungy-Poythress LJ, First MR. Successful pregnancy after combined renal-pancreas transplantation: a case report and literature review. Am J Perinatol 1996; 13: 383–387.

    Article  PubMed  CAS  Google Scholar 

  77. Karaitis LK, Nankivell BJ, Lawrence S, et al. Successful obstetric outcome after simultaneous pancreas and kidney transplantation. Med J Aust 1999; 170: 368–370.

    Google Scholar 

  78. Barrou BM, Gruessner AC, Sutherland DE, Gruessner RW. Pregnancy after pancreas transplantation in the cyclosporine era: report from the International Pancreas Transplant Registry. Transplantation 1998:65:524–527.

    Article  PubMed  CAS  Google Scholar 

  79. Davison JM. The effect of pregnancy on kidney function in renal allograft recipients. Kidney Int 1985; 27: 74–79.

    Article  PubMed  CAS  Google Scholar 

  80. First MR, Combs CA, Weiskittel P, Miodovnik M. Lack of effect of pregnancy on renal allograft survival or function. Transplantation 1995; 59: 472–476.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kitzmiller, J.L., Combs, C.A. (2000). Diabetic Nephropathy and Pregnancy. In: Mogensen, C.E. (eds) The Kidney and Hypertension in Diabetes Mellitus. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-4499-9_38

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-4499-9_38

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7028-4

  • Online ISBN: 978-1-4615-4499-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics