Vascular complications in diabetic pregnancy

Progression of diabetic retinopathy (DR) occurs at least temporarily during pregnancy and postpartum. Nephropathy is associated with increased risk of preeclampsia, nephrotic syndrome, preterm delivery, fetal growth restriction, and perinatal mortality. The degree of renal impairment and proteinuria in early pregnancy predict pregnancy complications in women with diabetic nephropathy. The main pregnancy complication in this respect is pre-eclampsia which increases with severity of proteinuria. Presence of retinopathy increases also risk of preeclampsia and also poor glycemic control. The pregnancy itself (first or subsequent) is not a long-term risk factor for developing microalbuminuria, any retinopathy, proliferative retinopathy, or neuropathy. These findings have practical implications for counselling young women in planning their pregnancies. Good glycemic control, normotension, lack of nephropathy as well as lack of pre-proliferative/proliferative changes of diabetic retinopathy are good prognostic factors as regards the progression of vascular complications during pregnancy. Women with Type 1 diabetes should be evaluated before pregnancy for microangiopathies, treated and followed closely during pregnancy by obstetrician and internist/diabetologue.