M. Hod et al., DIABETIC NEPHROPATHY AND PREGNANCY - THE EFFECT OF ACE-INHIBITORS PRIOR TO PREGNANCY ON FETOMATERNAL OUTCOME, Nephrology, dialysis, transplantation, 10(12), 1995, pp. 2328-2333
Background. Diabetic nephropathy is associated with an increase in per
inatal mortality and morbidity in uncontrolled pregnant patients. Rece
ntly angiotensin-converting enzyme inhibitor (ACE-I) was shown to impr
ove the disease status in non-pregnant subjects. The purpose of this s
tudy was to examine the effect of prepregnancy treatment of insulin-de
pendent diabetes mellitus (IDDM) nephrotic women with captopril angiot
ensin converting enzyme inhibitor (ACE-I), on maternal renal function
throughout pregnancy and on the fetomaternal outcome. Methods. Eight I
DDM nephrotic patients planning pregnancy were treated with captopril
for a minimum of 6 months prior to conception together with intensive
insulin management. Conception was allowed when proteinuria was < 500
mg/day and euglycaemia was achieved. At conception captopril was disco
ntinued. Results. At the beginning of captopril treatment, was 1633 +/
- 666 mg/day. At conception, proteinuria dropped to 273 +/- 146 mg/day
(P = 0.0000) and increased gradually over the three trimesters to 593
+/- 515, 783 +/- 813, and 1000 +/- 1185 mg/day respectively (P = 0.2
between the trimesters); declining to 619 +/- 411 mg/day (P = 0.0002 v
s conception) 3 months after delivery. Only in two patients (25%) did
proteinuria exceed 1000 mg/day during pregnancy. There was no signific
ant change in any of the other renal function tests: CCT, serum creati
nine, uric acid, K+ and blood pressure. However, there were three case
s of PET just prior to delivery. Maternal glycaemic control improved s
ignificantly prior to conception (P = 0.002) and remained euglycaemic
(reflected by daily glucose profile, HbA1C and fructosamine) throughou
t gestation. Perinatal outcome was excellent. Conclusion. Captopril tr
eatment before pregnancy has a prolonged protective effect on maternal
renal functions during pregnancy and results in a favourable maternal
-fetal outcome.