Endocrine Abstracts

Background: Diabetic nephropathy represents one of the most common causes of end-stage renal disease. During pregnancy it is associated with an increased perinatal morbidity as a striking result of the consistently high rate of preterm deliveries, mainly due to the frequent development of pre-eclampsia.

Aim: To describe pregnancy outcome in type 1 diabetic women with normoalbuminuria, microalbuminuria, or diabetic nephropathy after implementation of an intensified antihypertensive therapeutic strategy.

Design and methods: In our prospective study were enrolled 80 pregnant women with type 1 diabetes. Antihypertensive therapy, mainly methyldopa, was given to obtain blood pressure <135/85 mmHg and urinary albumin excretion <300 mg/24 h. Blood pressure and HbA1C were recorded during pregnancy. The pregnancy outcome was compared with recently published studies of pregnant women with microalbuminuria or diabetic nephropathy.

Results: Antihypertensive therapy was given in 9 of 54 women with normoalbuminuria, 8 of 18 women with microalbuminuria, and all eight women with diabetic nephropathy. Mean systolic blood pressure during pregnancy was 124 mmHg (range 105–151), 125 mmHg (119–138), and 138 mmHg (113–147) in women with normoalbuminuria, microalbuminuria, and diabetic nephropathy, respectively (P=0.0095). No differences in mean diastolic blood pressure or HbA1C were detected between the groups. No women with microalbuminuria developed preeclampsia. The frequency of preterm delivery was 22% in women with normoalbuminuria and microalbuminuria, in contrast to 75% in women with diabetic nephropathy (P<0.01) where the median gestational age was 254 days.

Conclusions: With intensified antihypertensive therapy and strict metabolic control, comparable pregnancy outcome was seen in type 1 diabetic women with microalbuminuria and normoalbuminuria. Diabetic nephropathy was associated with more adverse pregnancy outcome, compared to other studies.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.