ABSTRACT
Pregestational diabetes is a common complication of pregnancy that can be associated with severe maternal and fetal morbidity. In addition, some women could have progression of diabetic complications secondary to pregnancy. Preconception care can significantly reduce pregnancy complications with a dramatic impact on the diabetic mother and her infant. For those women whose condition could be hastened by conception education, better understanding and an improved decision should be available to them and their families. Because unplanned pregnancy is common among diabetic women, they should be counseled early for the importance of preconception care in the progression of this disease.
Subject(s)
Diabetes Complications/prevention & control , Preconception Care , Pregnancy in Diabetics/physiopathology , Prenatal Care , Congenital Abnormalities/physiopathology , Congenital Abnormalities/prevention & control , Coronary Disease/physiopathology , Diabetes Complications/physiopathology , Disease Progression , Female , Humans , Kidney Diseases/physiopathology , Pregnancy , Pregnancy OutcomeABSTRACT
Nephropathy is a complication of diabetes mellitus that can affect women in their reproductive years. Modern management has improved the outcome of class F diabetic mothers and their infants. Drug therapy to control glucose levels, and blood pressure, as well as identifying preconceptionally, women at high risk for complications are the cornerstone for the achievement of good outcomes. Fetal survival rates of 95 percent are achievable. Although many woman with diabetic neuropathy experience a transient decline in renal function during pregnancy, pregnancy per se does not appear to hasten the natural progression to end stage renal disease. The association between the progression of renal disease in individuals with diabetes mellitus and inadequate blood pressure control requires aggressive treatment. Systolic blood pressure above 130mmHg and diastolic above 85 mmHg in pregnant women with diabetic nephropathy should be treated. Although angiotensin converting enzyme (ACE) inhibitors should be avoided during pregnancy, agents such as calcium channel blockers can be used with equally good results. Furthermore, these agents seem to have similar long-term effects of antihypertensive drug use on normotensive pregnant women with overt proteinuria. Nevertheless, preconceptional treatment with either ACE-inhibitors or calcium channel blockers seem to have a positive effect on the development of proteinuria throughout pregnancy. Therefore, patients with diabetic nephropathy contemplating pregnancy may be counseled that pregnancy is not contraindicated; that with stringent metabolic and blood pressure control, maternal and perinatal survival rates as high; that maternal and neonatal morbidity remains increased; however, the intercurrent pregnancy is not expected to accelerate the rate of decline of renal disease in lost patients with diabetic nephropathy. However, selected subpopulation of patients with moderate to severe baseline renal impairment may experience acceleration in their renal disease. These patients would benefit from renal transplant or stable dialysis therapy before initating pregnancy.(Au)
Subject(s)
Female , Humans , Pregnancy , Diabetic Nephropathies/complications , Hypertension/complications , Pregnancy Outcome , Pregnancy Complications , Diabetic Nephropathies/drug therapy , Angiotensin-Converting Enzyme Inhibitors/therapeutic useABSTRACT
Nephropathy is a complication of diabetes mellitus that can affect women in their reproductive years. Modern management has improved the outcome of class F diabetic mothers and their infants. Drug therapy to control glucose levels, and blood pressure, as well as identifying preconceptionally, women at high risk for complications are the cornerstone for the achievement of good outcomes. Fetal survival rates of 95 percent are achievable. Although many woman with diabetic neuropathy experience a transient decline in renal function during pregnancy, pregnancy per se does not appear to hasten the natural progression to end stage renal disease. The association between the progression of renal disease in individuals with diabetes mellitus and inadequate blood pressure control requires aggressive treatment. Systolic blood pressure above 130mmHg and diastolic above 85 mmHg in pregnant women with diabetic nephropathy should be treated. Although angiotensin converting enzyme (ACE) inhibitors should be avoided during pregnancy, agents such as calcium channel blockers can be used with equally good results. Furthermore, these agents seem to have similar long-term effects of antihypertensive drug use on normotensive pregnant women with overt proteinuria. Nevertheless, preconceptional treatment with either ACE-inhibitors or calcium channel blockers seem to have a positive effect on the development of proteinuria throughout pregnancy. Therefore, patients with diabetic nephropathy contemplating pregnancy may be counseled that pregnancy is not contraindicated; that with stringent metabolic and blood pressure control, maternal and perinatal survival rates as high; that maternal and neonatal morbidity remains increased; however, the intercurrent pregnancy is not expected to accelerate the rate of decline of renal disease in lost patients with diabetic nephropathy. However, selected subpopulation of patients with moderate to severe baseline renal impairment may experience acceleration in their renal disease. These patients would benefit from renal transplant or stable dialysis therapy before initating pregnancy.