Q J Med 1999; 92: 451-454
© 1999 Association of Physicians
Pregnancy outcome in women with insulin-dependent diabetes mellitus complicated by nephropathy
1 From the Department of Diabetic Medicine and 2 Clinical Trials Unit, University Hospital Trust, and 3 Department of Obstetrics, Birmingham Womens Hospital Trust, Birmingham, UK
Received 27 October 1998 and in revised form 7 May 1999
Dr F.P. Dunne, Department of Diabetic Medicine, University Hospital Trust (Selly Oak), Raddlebarn Road, Birmingham B29 6JD
We retrospectively analysed pregnancy complicated by diabetic nephropathy in patients attending a University teaching hospital (1990–97), to examine fetal/maternal outcomes. Fetal outcomes included early intrauterine deaths, stillbirths, neonatal/perinatal mortality, size for gestational age, malformations, and need for neonatal unit care. Maternal outcomes included change in frequency of hypertension or severe proteinuria, serum creatinine data, and caesarean section rate. There were 21 pregnancies in 18 women, resulting in 21 live infants. Neonatal mortality (RR 10, 95%CI 0–3.9), perinatal mortality (RR 5, 95%CI 0–3.3) and congenital malformations (RR 5.0, 95%CI 0.3–26.3) were greater than in the background population. At delivery, 76% of babies were appropriate in size for gestational age; 57% were preterm, all of whom required neonatal unit care. The caesarean section rate was 90.5% vs. 20% in the background population (RR 4.5, 95%CI 3.4–5.0) (p<0.05). Hypertension frequency (p<0.001) and high-grade proteinuria (p<0.05) increased from booking to delivery. Although the take-home baby rate was 90%, perinatal/neonatal mortality, congenital malformations and caesarean sections, in addition to maternal morbidity, were significantly higher in women with diabetic nephropathy than in the background population.
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