Diabetic Nephropathy and Pregnancy

  • C. Andrew Combs
  • John L. Kitzmiller


Every practitioner who cares for adolescent and young adult diabetic women has an obligation to recognize that these women may become pregnant, that pregnancy poses serious risks to mother and offspring, that most of these risks are related to poor glycaemic control, and that the risks may be reduced through special programs that achieve meticulous metabolic control before conception and throughout pregnancy.


Diabetic Nephropathy Obstet Gynecol Fetal Distress Diabetic Woman Preconception Care 
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  1. 1.
    Combs CA, Kitzmiller JL. Spontaneous abortion and congenital malformations in diabetes. Bailliere’s Clin Obstet Gynaecol 1991; 5: 315–331.CrossRefGoogle Scholar
  2. 2.
    Mills JL, Knopp RH, Simpson JL, et al. Lack of relation of increased malformation rates in infants of diabetic mothers to glycémie control during organogenesis. N Engl J Med 1988; 318: 671–676.PubMedCrossRefGoogle Scholar
  3. 3.
    Dicker D, Feldberg D, Samuel N, Yeshaya A, Karp M, Goldman JA. Spontaneous abortion in patients with insulin-dependent diabetes mellitus: the effect of preconceptional diabetic control. Am J Obstet Gynecol 1988; 158: 1161–1164.PubMedGoogle Scholar
  4. 4.
    Rosenn B, Miodovnik M, Combs CA, Khoury J, Siddiqi TA. Pre-conception; management of insulin dependent diabetes: improvement of pregnancy outcome. Obstet Gynecol 1991; 77: 846–849.PubMedGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    Goldman JA, Dicker D, Feldberg D, et al. Pregnancy outcome in patients with insulin-dependent diabetes mellitus with preconceptional diabetic control: a comparative study. Am J Obstet Gynecol 1986; 155: 293–297.PubMedGoogle Scholar
  7. 7.
    Steel JM, Johnstone FD, Smith AF. Prepregnancy preparation. In: Sutherland H, Stowers J (eds). Fowett International Symposium on Carbohydrate Metabolism in Pregnancy. New York: Springer Verlag; 1988; pp. 1–9.Google Scholar
  8. 8.
    Damm P, Mølsted-Pedersen L. Significant decrease in congenital malformations in newborn infants of an unselected population of diabetic women. Am J Obstet Gynecol 1989; 161: 1163–1167.PubMedGoogle Scholar
  9. 9.
    Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD. Preconception care of diabetes. Glycémie control prevents congenital anomalies. JAMA 1991; 265: 731–736.PubMedCrossRefGoogle Scholar
  10. 10.
    Cousins L. Etiology and prevention of congenital anomalies among infants of overt diabetic women. Clin Obstet Gynecol 1991; 34: 481–493.PubMedGoogle Scholar
  11. 11.
    Stehouwer CDA, Fischer HRA, Hackeng WHL, den Ottolander GJH, Donker AJM. Diurnal variation in urinary protein excretion in diabetic nephropathy. Nephrol Dial Transplant 1991; 6: 238–243.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    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.PubMedGoogle Scholar
  14. 14.
    Brinchmann-Hansen O, Dahl-Jergensen K, Hanssen KF, et al. Effects of intensified insulin treatment on various lesions of diabetic retinopathy. Am J Ophthalmol 1985; 100: 644.PubMedGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Kitzmiller JL, Brown ER, Phillippe M, et al. Diabetic nephropathy and perinatal outcome. Am J Obstet Gynecol 1981; 141: 741–751.PubMedGoogle Scholar
  17. 17.
    Reece EA, Coustan DR, Hayslett JP, et al. Diabetic nephropathy: pregnancy performance and fetomaternal outcome. Am J Obstet Gynecol 1988; 159: 56–66.PubMedGoogle Scholar
  18. 18.
    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.PubMedGoogle Scholar
  19. 19.
    Wright A, Steele P, Bennett JR, Watts G, Polak A. The urinary excretion of albumin in normal pregnancy. Br J Obstet Gynaecol 1987; 94: 408–412.PubMedCrossRefGoogle Scholar
  20. 20.
    Cheung CK, Lao T, Swaminathan R. Urinary excretion of some proteins and enzymes during normal pregnancy. Clin Chem 1989; 35: 1978–1980.PubMedGoogle Scholar
  21. 21.
    Yasin SY, Bey Doun SN. Hemodialysis in pregnancy. Obstet Gynecol Surv 1988; 43: 655–668.PubMedCrossRefGoogle Scholar
  22. 22.
    Hou S. Pregnancy in women requiring dialysis for renal failure. Am J Kidney Dis 1987; 9: 368–375.PubMedGoogle Scholar
  23. 23.
    Moberg LJ, Freeman RK, Dorchester W. Diabetic nephropathy: evaluation of maternal fetal morbidity and risk factors for preeclampsia. Soc Perinat Obstet 1990; 10: 251 (abstract).Google Scholar
  24. 24.
    Combs CA, Rosenn B, Kitzmiller JL, Khoury JC, Wheeler BC, Miodovnik M. Early-pregnancy proteinuria in diabetes related to preeclampsia. Obstet Gynecol 1993; 82: 802–807.PubMedGoogle Scholar
  25. 25.
    Grenfell A, Brudenell JM, Doddridge MC, Watkins PJ. Pregnancy in diabetic women who have proteinuria. Q J Med 1986; 59: 379–386.PubMedGoogle Scholar
  26. 26.
    Greene MF, Hare JW, Krache M, Phillippe M, Barss VA, Saltzman DH, Nadel A, Younger MD, Heffner L, Scherl JE. Prematurity among insulin-requiring diabetic gravid women. Am J Obstet Gynecol 1989; 161: 106–111.PubMedGoogle Scholar
  27. 27.
    Yankowitz J, Piraino B, Laifer A, Frassetto L, Gavin L, Kitzmiller JL, Crombleholme W. Use of erythropoietin in pregnancies complicated by severe anemia of renal failure. Obstet Gynecol 1992; 80: 485–488.PubMedGoogle Scholar
  28. 28.
    Reece EA, Winn HN, Hayslett JP, Coulehan J, Wan M, Hobbins JC. Does pregnancy alter the rate of progression of diabetic nephropathy? Am J Perinat 1990; 7: 193–197.CrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    Selby JV, Fitz Simmons SC, Newman JM, Katz PP, Sepe S, Showstack J. The natural history and epidemiology of diabetic nephropathy: implications for prevention and control. JAMA 1990; 263: 1954–1960.PubMedCrossRefGoogle Scholar
  31. 31.
    Matson M, Kjellstrand CM. Long-term follow-up of 369 diabetic patients undergoing dialysis. Arch Intern Med 1988; 148: 600–606.PubMedCrossRefGoogle Scholar
  32. 32.
    Mølsted-Pedersen L. Data presented at Scientific Meeting of the American Diabetes Association (personal communication). 1992.Google Scholar
  33. 33.
    Biesenback G, Stoger H, Zazgornik 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.Google Scholar
  34. 34.
    Ogburn PL, Jr, Kitzmiller JL, Hare JW, et al. Pregnancy following renal transplantation in class T diabetes mellitus. JAMA 1986; 225: 911–915.CrossRefGoogle Scholar
  35. 35.
    Davison JM. The effect of pregnancy on kidney function in renal allograft recipients. Kidney Int 1985; 27: 74–79.PubMedCrossRefGoogle Scholar
  36. 36.
    Combs CA, Weiskittel P, Miodovnik M, Berlepsch S, First MR. Proceedings of the Xllth International Congress of Nephrology, 1993.Google Scholar
  37. 37.
    Imperiale TF, Petrulis AS. A meta-analysis of low-dose aspirin for the prevention of pregnancy-induced hypertensive disease. JAMA 1991; 266: 260–264.PubMedCrossRefGoogle Scholar
  38. 38.
    Friedman SA. Preeclampsia: a review of the role of prostaglandins. Obstet Gynecol 1988; 71: 122–137.PubMedGoogle Scholar
  39. 39.
    Sibai B, Caritis S, Phillips E, Klebanoff M, McNellis D, Rocco L, and the NICHD MFM Network, Bethesda, Maryland. Prevention of preeclampsia: low-dose aspirin in nulliparous women: a double-blind, placebo-controlled trial. Am J Obstet Gynecol 1993; 168: 286.Google Scholar
  40. 40.
    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.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • C. Andrew Combs
  • John L. Kitzmiller

There are no affiliations available

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