Diabetic nephropathy: pregnancy performance and fetomaternal outcome

A study of 31 continuing pregnancies complicated by diabetic nephropathy was conducted to determine the effects of diabetes-associated renal disease on maternal health and fetal outcome. Throughout pregnancy there was a significant increase in maternal blood pressure (p less than 0.001) and proteinuria (p less than 0.0001), with nephrotic syndrome (greater than 3.0 gm protein/day) developing in 71% of pregnancies. After birth, however, proteinuria reverted to levels not significantly different from values in early pregnancy. There was no apparent adverse effect of pregnancy on the natural course of the underlying renal disease. Stillbirths occurred in two patients (6%), and the remaining 29 pregnancies resulted in live-births at a mean gestational age of 36 weeks. Seventy percent of these infants were appropriate for gestational age, whereas 16% were small and 13% were large for gestational age. Birth weight was best correlated with gestational age and creatinine clearance (p less than 0.0001). Neonatal complications included respiratory distress syndrome (19%), hyperbilirubinemia (26), and congenital malformations (10%). The uncorrected perinatal survival rate was 94%. These data suggest that with contemporary methods of maternal evaluation and treatment, fetal surveillance, and neonatal care, the risks to patients with diabetic nephropathy during pregnancy are not excessive. The likelihood of a successful fetal and neonatal outcome is comparable to that in other patients with insulin-dependent diabetes.