MICROALBUMINURIA FOLLOWING GESTATIONAL DIABETES

Background. Microalbuminuria (MA) precedes clinical nephropathy in pat ients with insulin-dependent diabetes mellitus, and is associated with an increased mortality, mostly due to cardiovascular disease in patie nts with non-insulin-dependent diabetes mellitus. Microalbuminuria is rarely detected in patients with diabetes of less than five years' dur ation. Our study was designed to determine whether MA and its sequelae also appear 5-8 years after pregnancy complicated by gestational diab etes mellitus (GDM). Methods. We examined the presence of MA in 72 wom en who had not conceived since a previous GDM-pregnancy 5-8 years ago and compared them to a control group of 35 women who had no GDM histor y, and who were matched for age, parity and time since last pregnancy. Microalbuminuria was determined in all subjects using an overnight 8 hours urine collection. Mann-Whitney rank-sum test was used to compare data between the study and the control groups. Student's t test was u sed to compare data within the study group. Results. Median value of t he urinary albumin excretion rate (AER) in the study group was signifi cantly higher than median value of urinary AER of the control group (p <0.0001), but only 30.5% of the subjects of the study group were found to be microalbuminuria-positive, defined as urinary AER value of more than 21 mg/24 h. No correlation between MA and blood pressure, fastin g blood glucose, serum creatinine, blood urea nitrogen and parity was found. Conclusions. MA was found to be more frequent after GDM and no predisposing factors for its appearance were elucidated. Hence, we sug gest that it may well be a sign of early renal disease and that long-t erm follow-up of all GDM patients for MA and other markers of renal di sease is strongly indicated.