Diabetes in Pregnancy

Obstet Gynecol. 1996 Mar;87(3):401-9.

Perinatal outcome and long-term follow-up associated with modern management of diabetic nephropathy.
Gordon M, Landon MB, Samuels P, Hissrich S, Gabbe SG.

Department of Obstetrics and Gynecology, the Ohio State University College of Medicine, Columbus, OH, USA.

Objectives:

To determine outcomes in pregnancies complicated by class F diabetes mellitus cared for at a single center, and to assess renal function in these women.

Methods:

A retrospective review (1988-1994) of all pregnant women with class F diabetes was performed, as well as an evaluation of current renal function.

Results:

Forty-six pregnancies in 45 women reached a mean (+/- standard deviation) gestational age of 35.8 +/- 2.3 weeks, with a mean birth weight of 2623 +/- 818 g. No deliveries occurred before 30 weeks and 39 (84%) were at least 34 weeks. Perinatal survival was 100%. Women with initial serum creatinine exceeding 1.5 mg/dL or more than 3 g/24 hours proteinuria had an increased risk of early delivery, lower birth weight, preeclampsia, and cesarean delivery. Twenty-four individuals (53%) developed preeclampsia and seven met criteria for severe preeclampsia. By the third trimester, 26 women(58%) had greater than a 1 g/24 hour increase in proteinuria and 16 (36%) demonstrated more than a 15% fall in creatinine clearance. Follow-up was obtained in 34 subjects with a mean duration of 2.8 years. Individuals with initial creatinine clearance greater than 90 mL/minute and less than 1 g of protein per 24 hours had less loss of renal function at follow-up, as measured by creatinine clearance. At follow-up, mean protein excretion had decreased 1.9 g/24 hours from third-trimester values, but eight women (24%) maintained protein excretion exceeding 3 g/24 hours.

Conclusion:

Modern management of class F patients can result in good perinatal outcomes. Renal function studies early in pregnancy can be used to define the risk of perinatal morbidity and long-term progression of renal disease.