Pregnancy in women with diabetic kidney disease
- E Albert Reece, MD, PhD, MBA
E Albert Reece, MD, PhD, MBA
- Vice President for Medical Affairs,
- University of Maryland
- Dean, University of Maryland School of Medicine
- Matthew R Weir, MD
Matthew R Weir, MD
- Professor and Head
- Division of Nephrology
- University of Maryland School of Medicine
- Section Editors
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
- Michael F Greene, MD
Michael F Greene, MD
- Section Editor — Diabetes in Pregnancy
- Professor of Obstetrics and Gynecology
- Harvard Medical School
- Gary C Curhan, MD, ScD
Gary C Curhan, MD, ScD
- Section Editor — Chronic Kidney Disease
- Professor of Medicine
- Harvard Medical School
Women with either type 1 or type 2 diabetes mellitus can develop kidney disease during their childbearing years. It is usually due to classic diabetic nephropathy, which is characterized by albuminuria and progressive chronic kidney disease (CKD; ie, proteinuria, hematuria or decreased glomerular filtration rate [GFR] for three or more months (table 1), irrespective of cause ). In at least one study, the prevalence of microalbuminuria and diabetic nephropathy was nearly identical in pregnant women with type 1 versus type 2 diabetes . Albuminuria in women with diabetes is also occasionally due to a glomerular disease other than diabetic nephropathy.
In women with diabetic kidney disease who become pregnant, the presence of kidney disease raises important questions about the effects of the kidney disease on pregnancy outcome and the effects of pregnancy on risk of progressive kidney dysfunction. The management and outcome of pregnancy complicated by diabetic kidney disease will be reviewed here. General issues pertaining to the pathogenesis and treatment of diabetic kidney disease in nonpregnant individuals are discussed separately. (See "Overview of diabetic nephropathy" and "Glycemic control and vascular complications in type 1 diabetes mellitus" and "Treatment of diabetic nephropathy".)
LIMITATIONS OF AVAILABLE DATA
There are many challenges in presenting and interpreting the limited data available on pregnancy in women with diabetic kidney disease, including:
●The definitions/criteria for hypertension, albuminuria, and chronic kidney disease (CKD) have been modified over time and much of the available data on pregnancy in women with diabetic kidney disease predate these changes.
●It is very difficult to make the diagnosis of preeclampsia in patients who enter pregnancy with diabetic nephropathy, including hypertension and “significant” proteinuria. Escalation of both hypertension and the quantity of protein in the urine is nearly universal in these women in the third trimester, inevitably making the diagnosis of preeclampsia somewhat arbitrary in some or many cases.
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- LIMITATIONS OF AVAILABLE DATA
- EFFECT OF PREGNANCY ON DIABETIC KIDNEY DISEASE
- Kidney function
- EFFECT OF DIABETIC KIDNEY DISEASE ON PREGNANCY
- MANAGEMENT PRINCIPLES
- Treatment of hypertension
- Prevention of preeclampsia
- Antenatal care
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS