Improved Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria or Diabetic Nephropathy Effect of intensified antihypertensive therapy?

OBJECTIVE - To describe pregnancy outcome in type I 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 I diabetes. Antihypertensive therapy, mainly methyldopa, was given to obtain blood pressure < 135/85 mmHg and urinary albumin excretion <300 rng/24 h. Blood pressure and A1C were recorded during pregnancy. The pregnancy outcome was compared with recently published studies of pregnant women with microalbuminuria or diabetic nephropathy. RESULTS - Anti hypertensive therapy was given in 14 of 100 women with normoalbuminuria, 5 of 10 women with microalbuminuria, and all 7 women with diabetic nephropathy. Mean systolic blood pressure during pregnancy was 120 mmHg (range 101-147), 122 mmHg (116135), and 135 mmHg (111-145) in women With normoalbuminuria, microalbuminuria, and diabetic nephropathy, respectively (P = 0.0095). No differences in mean diastolic blood pressure or A1C 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 I diabetic women with microalbuminuria and normoalbuminuria. Although less severe than in previous studies, diabetic nephropathy was associated with more adverse pregnancy outcome.