Endocrine Abstracts

The aim of the present work was to assess the degree of glycemic control and complications rate through pregnancy and thirteen-years post-partum in women with microalbuminuria (T1DM).

Materials and methods

In total 191 patients with T1DM were enrolled in the study. Based on albuminuria levels in the 1^st trimester women were separated into 2 groups (Gr.). Gr.1 – 116 women with normoalbuminuria, Gr.2 – 75 women with microalbuminuria. Preconception care was performed in 46.5%- Gr.1 and 57.3% -Gr.2. Strict metabolic control was maintained and fetal surveillance was performed throughout the pregnancy. Repeated examinations –13 years post-partum.

Results

At entry HbA1c(%) levels for Gr.1 and 2 were: 7.42 (0.15) and 7.25 (0.14); by the end of the pregnancies they statistically decreased in both groups (Gr.1- P = 0.000, Gr.2 – P = 0.000). At entry percent (%) of retinopathy for Gr.1- 8.6 and Gr.2–20.0; by term the percent has not increased. The percent of women with macroalbuminuria increased, together with the growth of gestational age. By term macroalbuminuria was observed in 2.5% (Gr.1) and in 14.6% (Gr.2) of patients (P = 0.0094, OR-5.67). In Gr.1 percent of pre-eclampsia and preterm deliveries before 37 weeks of gestation was lower, than in Gr.2 (pre-eclampsia – P = 0.0064, OR –4.64; preterm deliveries P = 0.048; OR –2.8). Perinatal mortality was observed in Gr.1 – 0.8% and in Gr.2 – 6.6% of women (P – 0.006, OR – 7.73). Repeated examinations 13 years post-partum showed that HbA1c levels were statistically higher, than at the end of pregnancy: Gr.1–7.7 (0.41) (P = 0.0002), Gr.2 – 8.05 (0.26) (P = 0.000). Repeated examinations showed that percent of retinopathy, micro and macroalbuminuria, increased in both groups. Besides, patients from Gr.2 had statistically higher complications rate, than patients from Gr.1 (retinopathy – P = 0.0002, OR – 3.45; microalbuminuria – P < 0.0001, OR – 10.2; macroalbuminuria – P = 0.0032, OR- 3.03). Chronic kidney disease (stage 3–6) were observed in 36 patents. Nine patients from Gr.2 are on regular hemodialysis, and in two patient kidney transplantation was performed.

Conclusion

If microalbuminuria was detected in the 1^st trimester, the risk of preeclampsia increased 4.6 times, the risk of preterm delivery increased 2.8 times and risk of perinatal mortality increased 7.3 times, compared to patients with normoalbuminuria. In both groups glycemia control deterioration was observed thirteen years post-partum. The higher complication percent was found if pregnancy proceeded with microalbuminuria, the risk of retinopathy increased 3.4 times and the risk of CKD increased 3 times compared to patients with normoalbuminuria.