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Pregnancy in women with diabetic kidney disease

Authors
E Albert Reece, MD, PhD, MBA
Matthew R Weir, MD
Section Editors
David M Nathan, MD
Michael F Greene, MD
Gary C Curhan, MD, ScD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

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 [1]). 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 [2]. 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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Literature review current through: Nov 2016. | This topic last updated: Tue Oct 04 00:00:00 GMT+00:00 2016.
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