Pregnancy and diabetic nephropathy

Abstract

Pregnancy in women with diabetic nephropathy may have significant maternal and fetal risks but with a comprehensive, team-based approach to care usually results in successful outcomes. Providing care to these women requires a thorough understanding of the experience that has been gathered over the last 50 years and the lessons learned by those who have published these data and been actively involved in the care of pregnant diabetics. The following chapter reviews the potential and likely risks of pregnancy in women with diabetes who develop gestational diabetes or who have microalbuminuria, proteinuria, and/or reduced renal function. This information is also necessary for pre-pregnancy counseling for women with diabetic nephropathy. Women with diabetic nephropathy are likely to develop increased proteinuria, have a significantly increased risk of preeclampsia, and are more likely to experience preterm delivery and intrauterine growth retardation. The likelihood of accelerating the progression of renal disease depends on the prepartum renal function. The purpose of this review is to provide all physicians who care for pregnant women with diabetic nephropathy the necessary background and knowledge that will allow for evidence-based decision making and the greatest likelihood of successful outcomes for these patients.