Pregnancy in women with diabetic nephropathy

Diabetes is a chronic metabolic disorder characterized by either absolute or relative insulin deficiency resulting in increased glucose concentrations. Diabetes in pregnant women may be pre-gestational (diabetes diagnosed before pregnancy) or gestational (diabetes diagnosed during pregnancy). The incidence of diabetic nephropathy (DN) is related to the duration of diabetes; approximately 15% develop nephropathy within 15 years, 30% within 20 years, and 40% within 30 years from the onset of diabetes. Once nephropathy is established renal function deteriorates progressively. Therefore in women of reproductive age with diabetes, a major concern is whether pregnancy increases the risk for DN and/or accelerates the progression of DN. Diabetic nephropathy complicates approximately 5% of pregnancies in women with pre-existing diabetes. Pre-eclampsia, preterm birth, and fetal growth restriction are the major obstetrical complications in these women. Further, women with pre-pregnancy creatinine >1.5 mg/dL have the highest perinatal complication rate. However, with close evaluation and management, pregnancy outcomes in women with DN have been good, but not completely without risks. This requires a close teamwork between the obstetricians and the nephrologists.