Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding

TY - JOUR

T1 - Diabetic Nephropathy in Women With Preexisting Diabetes

T2 - From Pregnancy Planning to Breastfeeding

AU - Ringholm, Lene

AU - Damm, Julie Agner

AU - Vestgaard, Marianne

AU - Damm, Peter

AU - Mathiesen, Elisabeth

PY - 2016/2/1

Y1 - 2016/2/1

N2 - In women with preexisting diabetes and nephropathy or microalbuminuria, it is important to deliver careful preconception counselling to assess the risk for the mother and the foetus, for optimizing glycaemic status and to adjust medical treatment. If serum creatinine is normal in early pregnancy, kidney function is often preserved during pregnancy, but complications such as severe preeclampsia and preterm delivery are still common. Perinatal mortality is now comparable with that in women with diabetes and normal kidney function. Besides strict glycaemic control before and during pregnancy, early and intensive antihypertensive treatment is important to optimize pregnancy outcomes. Methyldopa, labetalol, nifedipine and diltiazem are considered safe, whereas angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers should be stopped before or at confirmation of pregnancy. Supplementation with folic acid in early pregnancy and low-dose aspirin from 10 to 12 weeks reduces the risk of adverse pregnancy outcomes. During breastfeeding, several ACE inhibitors are considered safe.

AB - In women with preexisting diabetes and nephropathy or microalbuminuria, it is important to deliver careful preconception counselling to assess the risk for the mother and the foetus, for optimizing glycaemic status and to adjust medical treatment. If serum creatinine is normal in early pregnancy, kidney function is often preserved during pregnancy, but complications such as severe preeclampsia and preterm delivery are still common. Perinatal mortality is now comparable with that in women with diabetes and normal kidney function. Besides strict glycaemic control before and during pregnancy, early and intensive antihypertensive treatment is important to optimize pregnancy outcomes. Methyldopa, labetalol, nifedipine and diltiazem are considered safe, whereas angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers should be stopped before or at confirmation of pregnancy. Supplementation with folic acid in early pregnancy and low-dose aspirin from 10 to 12 weeks reduces the risk of adverse pregnancy outcomes. During breastfeeding, several ACE inhibitors are considered safe.

KW - Breast Feeding

KW - Diabetic Nephropathies

KW - Female

KW - Humans

KW - Neovascularization, Pathologic

KW - Pre-Eclampsia

KW - Pregnancy

KW - Pregnancy Outcome

KW - Treatment Outcome

KW - Journal Article

KW - Review

U2 - 10.1007/s11892-015-0705-3

DO - 10.1007/s11892-015-0705-3

M3 - Review

C2 - 26803648

SN - 1534-4827

VL - 16

JO - Current Diabetes Reports

JF - Current Diabetes Reports

M1 - 12

ER -