Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

• Published in: Diabetologia Vol. 58; no. 4; pp. 678 - 686
• Main Authors: Klemetti, Miira M., Laivuori, Hannele, Tikkanen, Minna, Nuutila, Mika, Hiilesmaa, Vilho, Teramo, Kari
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2015; Springer Nature B.V
• Subjects: Adult; Antihypertensive Agents - therapeutic use; Antihypertensives; Biomarkers - blood; Blood Glucose - metabolism; Blood Pressure; Cesarean Section; Childbirth & labor; Creatinine; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 1 - therapy; Diabetic Nephropathies - blood; Diabetic Nephropathies - etiology; Diabetic Nephropathies - physiopathology; Diabetic Nephropathies - therapy; Diabetic nephropathy; Elective Surgical Procedures; Emergencies; Female; Glycated Hemoglobin A - metabolism; Gynecology; Hospitals; Human Physiology; Humans; Hypoglycemic Agents - therapeutic use; Infant, Newborn; Intensive care; Intensive Care Units, Neonatal; Internal Medicine; Kidney - physiopathology; Medicine; Medicine & Public Health; Metabolic Diseases; Mortality; Obstetrics; Patient Admission; Plasma; Pre-Eclampsia - blood; Pre-Eclampsia - etiology; Pre-Eclampsia - physiopathology; Pre-Eclampsia - therapy; Preeclampsia; Pregnancy; Pregnancy in Diabetics; Premature birth; Premature Birth - blood; Premature Birth - etiology; Premature Birth - physiopathology; Premature Birth - therapy; Proteins; Retrospective Studies; Risk Factors; Time Factors; Urine; Womens health; Young Adult; Finland; Perinatal outcome; Type 1 diabetes; Diabetic nephropathy; Obstetric outcome; Blood pressure; Pre-eclampsia; Antihypertensive medication; Glycaemic control
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-014-3488-1

Aims/hypothesis
Our aim was to analyse possible changes in the glycaemic control, BP, markers of renal function, and obstetric and perinatal outcomes of parturients with diabetic nephropathy during 1988–2011.
Methods
The most recent childbirth of 108 consecutive type 1 diabetes patients with diabetic nephropathy and a singleton pregnancy were studied. Two periods, 1988–1999 and 2000–2011, were compared.
Results
The prepregnancy and the first trimester median HbA
1c
values persisted at high levels (8.2% [66 mmol/mol] vs 8.5% [69 mmol/mol],
p
 = 0.16 and 8.3% [67 mmol/mol] vs 8.4% [68 mmol/mol],
p
 = 0.67, respectively), but decreased by mid-pregnancy (6.7% [50 mmol/mol] vs 6.9% [52 mmol/mol],
p
 = 0.11). Antihypertensive medication usage increased before pregnancy (34% vs 65%,
p
 = 0.002) and in the second and third trimesters of pregnancy (25% vs 47%,
p
 = 0.02, and 36% vs 60%,
p
 = 0.01, respectively). BP exceeded 130/80 mmHg in 62% and 61% (
p
 = 0.87) of patients in the first trimester, and in 95% and 93% (
p
 = 0.69) in the third trimester, respectively. No changes were observed in the markers of renal function. Pre-eclampsia (52% vs 42%,
p
 = 0.29) and preterm birth rates before 32 and 37 gestational weeks (14% vs 21%,
p
 = 0.33, and 71% vs 77%,
p
 = 0.49, respectively) remained high. The elective and emergency Caesarean section rates were 71% and 45% (
p
 = 0.01) and 29% and 48% (
p
 = 0.05), respectively. Neonatal intensive care unit admissions increased from 26% to 49% (
p
 = 0.02).
Conclusions/interpretation
Early pregnancy glycaemic control and hypertension management were suboptimal in both time periods. Pre-eclampsia and preterm delivery rates remained high in patients with diabetic nephropathy.