Diabetic Nephropathy And Pregnancy

John L. Kitzmiller, MD

Regional Diabetes and Pregnancy Program, Good Samaritan Hospital, San Jose, California, USA

The potential problems of diabetic nephropathy (DN) and pregnancy require the anticipation of preconception care. Clinicians who care for adolescent and adult diabetic women need to recognize that they may become pregnant, that most of the risks to mother and offspring are related to poor control of hyperglycemia and hypertension, and that the risks may be reduced through intensified multifactorial interventions before conception and throughout pregnancy.

In recent years the most common cause of perinatal mortality in type 1 or type 2 diabetes is major congenital malformations [1]. A major advance is the demonstration that most malformations can be prevented by institution of strict metabolic control before conception in women with diabetic vascular complications [2-5]. Patients should have instruction in contraception [6-9] and should be intensively treated or referred to a specialized center when pregnancy is considered. Encouragement by diabetes care providers is a major factor in preventing unplanned pregnancies [10-11].

In the past, women with DN were generally advised to avoid pregnancy because there was a low probability of a healthy infant and a chance that nephropathy would worsen. Although advances in obstetrical and neonatal care have improved the outlook, nephropathy in pregnancy still presents a challenging situation requiring coordination between the patient and providers from many specialties. As reviewed in this chapter, women with nephropathy remain at high risk for many pregnancy complications, including superimposed

Mogensen CE (ed.) THE KIDNEY AND HYPERTENSION IN DIABETES MELLITUS. Copyright© 2004 by Martin Dunitz, a member of the Taylor & Francis Group, plc. All rights reserved.

preeclamptic toxemia (PET) or accelerated hypertension, preterm delivery, fetal growth restriction, and cesarean delivery. Excellent metabolic balance and control of hypertension are necessary to reduce these complications and prevent decline in renal and retinal function during and after pregnancy.

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