Improved Pregnancy Outcome In Type 1 Diabetic Women With Microalbuminuria Or Diabetic Nephropathy – Effect Of Intensified Antihypertensive Therapy?

Abstract

Objective: To describe pregnancy outcome in type 1 diabetic women with normoalbuminuria, microalbuminuria or diabetic nephropathy after implementation of an intensified antihypertensive therapeutic strategy.

Research, design and methods: Prospective study of 117 pregnant women with type 1 diabetes. Antihypertensive therapy, mainly methyldopa, was given to obtain blood pressure (BP) <135/85 mmHg and urinary albumin excretion <300 mg/24h. BP and HbA1c were recorded during pregnancy. The pregnancy outcome was compared with recently published studies of pregnant women with microalbuminuria or diabetic nephropathy.

Results: Antihypertensive therapy was given in 14 of 100 women with normoalbuminuria, five of 10 women with microalbuminuria and all seven women with diabetic nephropathy. Mean systolic BP during pregnancy was 120 mmHg (range 101-147), 122 mmHg (116-135) and 135 mmHg (111-145) in women with normoalbuminuria, microalbuminuria and diabetic nephropathy (p=0.0095). No differences in mean diastolic BP or HbA1c were detected between the groups. No women with microalbuminuria developed preeclampsia. The frequency of preterm delivery was 20% in women with normoalbuminuria and microalbuminuria in contrast to 71% in women with diabetic nephropathy (p<0.01) where the median gestational age was 258 days (220-260). Compared with previous studies using less stringent antihypertensive therapeutic strategy and less strict metabolic control, gestational age was longer and birth weight was larger in our study.

Conclusions: With intensified antihypertensive therapy and strict metabolic control, comparable pregnancy outcome was seen in type 1 diabetic women with microalbuminuria and normoalbuminuria. Though less severe than in previous studies, diabetic nephropathy was associated with more adverse pregnancy outcome.