Skip to main content
SpringerLink
Log in
Book cover

Pregnancy and Renal Disorders pp 65–90Cite as

Pregnancy and Diabetic Nephropathy

  • Chapter

  • 44 Accesses

Part of the book series: New Clinical Applications ((NCNG,volume 4))

Abstract

Successful pregnancy depends on the ability of maternal physiology to adjust to the demands of the feto-placental unit1. In women with diabetes mellitus (DM), however, multisystem functional and occasionally anatomical changes may accompany the metabolic abnormalities which characterize the condition1,2. Pregnancy in a woman with DM thus merits particular attention. The ultimate goal in any pregnant woman is to achieve a healthy baby who will integrate into an enduring family unit. Both husband and wife need to appreciate the problems associated with diabetic pregnancy and the implications of diabetic complications, such as nephropathy, on long-term lifestyle, health and survival. To achieve the goal of a successful pregnancy in a young woman with insulin-dependent diabetes mellitus (IDDM), especially if microvascular complications are present, the patient requires knowledge of the importance of prepregnancy and pregnancy glycaemic control, the skills and facilities to achieve such control, the outlook and lifestyle which will allow her to apply her knowledge and skills, and careful co-ordinated care by a team comprising an experienced obstetrician, physician and neonatologist. Motivation to achieve this outcome is normally very hight and most diabetic women can be reassured about a successful outcom of pregnancy.

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

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

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Sutherland, H.W. and Stowers, J.M. (1984). Carbohydrate Metabolism in Pregnancy and the Newborn. (Edinburgh: Churchill Livingstone)

    Google Scholar 

  2. Hadden, D. R. (1986). Diabetes in pregnancy 1985. Diabetologia, 29, 1–9

    Article  PubMed  CAS  Google Scholar 

  3. Molsted-Pedersen, L. and Kuhl, C. (1986). Obstetrical management in pregnancy. The Copenhagen Experience. Diabetologia, 29, 13–16

    Article  PubMed  CAS  Google Scholar 

  4. Drury, M.I. (1986). Management of the pregnant diabetic patients — are the pundits right? Diabetologia, 29, 10–12

    Article  PubMed  CAS  Google Scholar 

  5. National Diabetes Data Group (1979). Classification and diagnosis of diabetes and other categories of glucose intolerance. Diabetes, 28, 1039–1057

    Google Scholar 

  6. Gorsuch, A.M., Lister, J., Dean, B.M., Spencer, K.M., McNally, J.M., Bottazzo, J.F. and Cudworth, A.G. (1981). Evidence for a long pre diabetic period in type I (insulin dependent) diabetes mellitus. Lancet, 2, 1363–1365

    Article  PubMed  CAS  Google Scholar 

  7. Johnston, C, Yook, D.A., Cudworth, A.G. and Wolfe, E. (1983). HLA DR typing in identical twins with insulin dependent diabetes: difference between concordant and discordant pairs. Br. Med. J., 286, 253–256

    Article  CAS  Google Scholar 

  8. Yoon, J.W., Austin, M., Onidara, T. and Notkins, A.L. (1979). Virus induced diabetes mellitus; isolation of a virus from the pancreas of a child with diabetic ketoacidosis. N. Engl. J. Med., 300, 1173–1179

    Article  PubMed  CAS  Google Scholar 

  9. Helgason, T. and Jonasson, M.R. (1981). Evidence for a food additive as a cause of ketosis prone diabetes. Lancet, 2, 716–720

    Article  PubMed  CAS  Google Scholar 

  10. Toliona, A., Onodera, T., Yoon, J.W. and Notkins, A.L. (1980). Induction of diabetes by cumulative environmental insults from viruses and chemicals. Nature (London), 288, 383–385

    Article  Google Scholar 

  11. Lernmark, A., Haggloff, B., Freedman, Z., Irvine, J., Ludvigsson, J. and Holmgren, G. (1981). A prospective analysis of antibodies reacting with pancreatic islet cells in insulin dependent diabetic children. Diabetologia, 20, 4, 471–474

    Article  PubMed  CAS  Google Scholar 

  12. Sensi, M., Poxolli, P., Gorsuch, A.N., Bottazzo, G.F. and Cudworth, A.G. (1981). Increased killer cell activity in insulin dependent (type I) diabetes mellitus. Diabetologia, 20, 106–109

    Article  PubMed  CAS  Google Scholar 

  13. De Fronzo, R. and Ferranini, E. (1982). The pathogenesis of non insulin dependent diabetes: an update. Medicine (Baltimore), 61, 125–140

    Google Scholar 

  14. Keen, H. and Jarrett, J. (1982). Complications of Diabetes, 2nd Edn. (London: Edward Arnold)

    Google Scholar 

  15. Stewart-Brown, S., Haslem, M. and Butler, N. (1983). Evidence for increasing prevalence of diabetes mellitus in childhood. Br. Med. J., 286, 1855–1857

    Article  CAS  Google Scholar 

  16. Rodmann, H.M. (1979). Diabetic nephropathy. Impact on the prognosis of the pregnant diabetic woman. In Merkatz, I.R. and Adam, P.A.J, (eds.) The Diabetic Pregnancy. A Perinatal Perspective, pp. 57–71. (New York: Grune and Stratton)

    Google Scholar 

  17. Furhrmann, K., Reiher, H., Semmler, K., Fischer, F., Fischer, M. and Glockner, E. (1983). Prevention of congenital malformations in infants of insulin dependent diabetic mothers. Diabetes Care, 6, 219–223

    Article  Google Scholar 

  18. Steel, J.M., Johnstone, F.D., Smith, A.F. and Duncan, L.J.P. (1984). Pre-preg nancy clinic approach. In Sutherland, H.W. and Stowers, J.M. (eds.) Carbohydrate Metabolism in Pregnancy and the Newborn, pp. 75–86. (Churchill Livingstone)

    Google Scholar 

  19. Hytten, F. and Chamberlain, G. (1980). Clinical Physiology in Obstetrics. (Oxford: Blackwell Scientific Publications)

    Google Scholar 

  20. Andersen, A.R., Christiansen, J.S., Andersen, J.K., Kreiner, S. and Deckert, T. (1983). Diabetic nephropathy in type I (insulin dependent) diabetes: an epidemiological study. Diabetologia, 25, 496–501

    Article  PubMed  CAS  Google Scholar 

  21. Christiansen, J.S. (1985). Glomerular hyperfiltration in diabetes mellitus. Diabetic Med., 2, 235–239

    Article  PubMed  CAS  Google Scholar 

  22. Parving, H.H., Nower, I., Kehlet, H., Morgensen, C.E., Fendsen, P.A.A. and Heading, L.G. (1977). The effect of short term glucagon infusion on kidney function in normal man. Diabetologia, 13, 323–325

    Article  PubMed  CAS  Google Scholar 

  23. Christiansen, J.S., Gammelgaarde, J., Franzsen, M., Orskoff, H. and Parving, H.H. (1982). Kidney function and size in type I diabetic patients before and during growth hormone administration for one week. Diabetologia, 22, 333–337

    Article  PubMed  CAS  Google Scholar 

  24. Viberti, G. and Keen, H. (1984). The patterns of proteinuria in diabetes mellitus — relevance to pathogenesis and prevention of diabetic nephropathy. Diabetes, 33, 686–692

    PubMed  CAS  Google Scholar 

  25. Viberti, G., Pickup, J.C., Jarrett, R.J. and Keen, H. (1979). Effect of control of blood glucose on urinary excretion of albumin and beta 2 microglobulin in insulin dependent diabetes. N. Engl. J. Med., 300, 638–641

    Article  PubMed  CAS  Google Scholar 

  26. Viberti, G.C., Wiseman, M.J. and Bending, J.J. (1986). Prevention of diabetic nephropathy: markers of disease and perspectives for intervention. Diabetic Med., 3, 208–211

    Article  PubMed  CAS  Google Scholar 

  27. Bell, E.T. (1953). Renal vascular disease in diabetes mellitus. Diabetes, 2, 376–389

    PubMed  CAS  Google Scholar 

  28. Mauer, S.M., Barbosa, J. and Vernier, R.L. (1976). Development of diabetic vascular lesions in normal kidneys transplanted into patients with diabetes mellitus. N. Engl. J. Med., 295, 916–920

    Article  PubMed  CAS  Google Scholar 

  29. Bloodworth, J.M.B., Engerman, R.L. and Anderson, P.J. (1973). Microangiopathy in the experimentally diabetic animal. In Calmerini-Davalos, R.A. and Cole, H.S. (eds.) Vascular and Neurological Changes in Early Diabetes, pp. 245. (New York: Academic Press)

    Google Scholar 

  30. Bunn, F.H. (1981). Evaluation of glycosylated haemoglobin in diabetic patients. Diabetes, 30, 613–617

    PubMed  CAS  Google Scholar 

  31. Stevens, V.J., Rouzer, C.A., Monnier, V.M. and Cerami, A. (1978). Diabetic cataract formation: role of glycosylation of lens crystallins. Proc. Natl. Acad. Sci., 75, 2918–2922

    Article  PubMed  CAS  Google Scholar 

  32. Schnider, S.L. and Kohn, R.R. (1980). Glycosylation of human collagen in aging and diabetes mellitus. J. Clin. Invest., 66, 1179–1181

    Article  PubMed  CAS  Google Scholar 

  33. Kennedy, L., Mehl, T.D., Elder, E., Varghese, M. and Merinee, T.J. (1982). Nonenzymatic glycosylation of serum and plasma proteins. Diabetes, 31, (Suppl. 3), 52–56

    CAS  Google Scholar 

  34. Witztum, J.L., Mahoney, E.M., Branks, M.J., Fisher, M., Elam, R. and Steinberg, D. (1982). Non-enzymatic glycosylation of low density lipoprotein alters its biologic activity. Diabetes, 31, 283–291

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  36. Ogburn, P.L., Kitzmiller, J.L., Hare, J.W., Phillippe, M., Gabbe, S.G., Miodovnik, M., Tagatz, G.E., Nagal, T.G., Williams, P.P., Goetz, F.C., Barbosa, J.J. and Sutherland, D.F. (1986). Pregnancy following renal transplantation in Class T diabetes mellitus. J. Am. Med. Assoc., 255, 911–915

    Article  Google Scholar 

  37. Reece, E.A., Egan, J.F.X., Coustan, D.R., Tamborlane, W., Bates, S.E., O’Neil, T. and Fitzpatrick, J.G. (1985). Coronary artery disease in diabetic pregnancy. Am. J. Obstet. Gynaecol, 154/1, 150–151

    Google Scholar 

  38. Pedersen, J.F., Molsted-Pedersen, L. and Mortensen, H.B. (1984). Fetal growth delay and maternal hemoglobin A1C in early diabetic pregnancy. Obstet. Gynaecol, 64, 351–356

    CAS  Google Scholar 

  39. Hare, J.W. and White, P. (1980). Gestational diabetes and White Classification. Diabetes Care, 3, 2, 394

    Google Scholar 

  40. Lind, T. and Anderson, J. (1984). Does random blood glucose sampling outdate testing for glycosuria in the detection of diabetes during pregnancy? Br. Med. J., 289, 1569–1571

    Article  CAS  Google Scholar 

  41. Freinkel, N. (1985). Proceedings of the Second International Workshop-Conference on gestational diabetes mellitus. Diabetes, 34, (suppl. 2), 1–130

    PubMed  Google Scholar 

  42. Mylvaganam, R., Stowers, J.M., Steel, J.M., Wallace, J., MacHendry, J.C. and Wright, A.D. (1983). Insulin immunogenicity in pregnancy: maternal and fetal studies. Diabetologia, 24, 19–25

    Article  PubMed  CAS  Google Scholar 

  43. Serup, L. (1986). Influence of pregnancy on diabetic retinopathy. Acta Endocrinol Suppl, 277, 122–124

    CAS  Google Scholar 

  44. Phelps, R.L., Sakol, P., Metzger, B.M., Jampol, L.M., Frienkel, N. (1986). Changes in diabetic nephropathy during pregnancy. Arch. Ophthalmol, 104, 1806–1810

    PubMed  CAS  Google Scholar 

  45. Wright, A., Steel, P., Bennett, J.R., Watts, G. and Polak, A. (1987). The urinary excretion of albumin in normal pregnancy. Br. J. Obstet. Gynaecol, 94, 408–412

    Article  PubMed  CAS  Google Scholar 

  46. Grenfell, A., Brudenell, J.M., Doddridge, M.C. and Watkins, P.J. (1986). Pregnancy in diabetic women who have proteinuria. Q. J. Med., 59, 379–386

    PubMed  CAS  Google Scholar 

  47. Nesler, C.L., Sinclair, S.H., Swartz, S.S. and Gabbe, S.J. (1985). Diabetic nephropathy in pregnancy. Clin. Obstet. Gynaecol, 28, 528

    Article  CAS  Google Scholar 

  48. Diamond, M.P., Shah, D.M., Hester, R.A., Vaughn, W.K., Cotton, R.B. and Boehm, F.H. (1985). Complication of insulin dependent diabetic pregnancies by pre eclampsia and/or chronic hypertension: analysis of outcome. Am. J. Perinatol, 2, 263–267

    Article  PubMed  CAS  Google Scholar 

  49. Jovanovic, R. and Jovanovic, L. (1984). Obstetric management when normoglycaemia is maintained in diabetic pregnant women with vascular compromise. Am. J. Obstet. Gynaecol, 149, 617–623

    CAS  Google Scholar 

  50. Kitzmiller, J.L., Brown, E.R., Phillippe, M., Stark, A.R., Acker, D., Kaldany, A., Singh, S. and Hare, J.W. (1981). Diabetic nephropathy and perinatal outcome. Am. J. Obstet. Gynaecol, 147, 741–751

    Google Scholar 

  51. Hare, J.W. and White, P. (1977). Pregnancy in diabetes complicated by vascular disease. Diabetes, 26, 953–955

    Article  PubMed  CAS  Google Scholar 

  52. Dicker, D., Feldberg, D., Peleg, D., Karp, M. and Goldman, J.A. (1986). Pregnancy complicated by diabetic nephropathy. J. Perinatol. Med., 14, 299–305

    Article  CAS  Google Scholar 

  53. Persson, B., Heding, L.G., Lunell, N.O., Psechera, H., Stangenberg, M. and Wagner, J. (1982). Fetal beta cell function in diabetic pregnancy. Am. J. Obstet. Gynaecol, 144, 455–459

    CAS  Google Scholar 

  54. Pedersen, J. (1975). Fetal macrosomia. In Sutherland, H.W. and Stowers, J.M. (eds.) Carbohydrate Metabolism in Pregnancy and the Newborn, pp. 127–139. (Edinburgh: Churchill Livingstone)

    Google Scholar 

  55. Freinkel, N., Phelps, R.E. and Betzger, B.E. (1978). Intermediary metabolism during normal pregnancy. In Sutherland, H.W. and Stowers, J.M. (eds.) Carbohydrate Metabolism in Pregnancy and the Newborn, pp. 1–31. (Basle: Springer Verlag)

    Google Scholar 

  56. Widness, J.A., Susa, J.B., Garcia, J.F., Singer, D.B., Sengal, P., Ol, W., Schwartz, R. and Schwartz, H.C. (1981). Increased erythropoietin in infants born to diabetic mothers and in hyperinsulinaemic rhesus fetuses. J. Clin. Invest., 67, 637–642

    Article  PubMed  CAS  Google Scholar 

  57. Turnbridge, W.M.G. (1981). Factors contributing to deaths of diabetics under 50 years of age. Lancet, 2, 569–572

    Article  Google Scholar 

  58. Borch-Johnsen, K. and Kreiner, S. (1987). Proteinuria — value as a predictor of cardiovascular mortality in insulin dependent diabetes mellitus. Br. Med. J., 294, 1651–1654

    Article  CAS  Google Scholar 

  59. Parving, H.H., Andersen, A.R., Smidt, U.M., Hommel, E., Mathiesen, E.R. and Svendsen, P.A. (1987). The effect of antihypertensive treatment on kidney function in diabetic nephropathy. Br. Med. J., 294, 1443–1447

    Article  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. D. W. M. Pearson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. W. Sutherland
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. University of Aberdeen, UK

    G. R. D. Catto DSc, MD, FRCP (Lond., Edin. and Glasg.) (Professor in Medicine and Therapeutics) (Professor in Medicine and Therapeutics)

Rights and permissions

Reprints and permissions

Copyright information

© 1988 Kluwer Academic Publishers

About this chapter

Cite this chapter

Pearson, D.W.M., Sutherland, H.W. (1988). Pregnancy and Diabetic Nephropathy. In: Catto, G.R.D. (eds) Pregnancy and Renal Disorders. New Clinical Applications, vol 4. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-2615-8_4

Download citation

  • DOI: https://doi.org/10.1007/978-94-009-2615-8_4

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-7680-7

  • Online ISBN: 978-94-009-2615-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation