INCREASES IN SERUM-LIPIDS DURING PREGNANCY IN TYPE-1 DIABETIC WOMEN WITH NEPHROPATHY

During pregnancy women with Type 1 diabetes do not differ from normal women with respect to pregnancy-associated changes in serum lipid leve ls. However influence of diabetic nephropathy on lipoprotein metabolis m in pregnancy has not been described previously. Changes in lipids we re compared during and after pregnancy in 10 Type 1 diabetic women wit hout macroproteinuria as well as in 5 diabetic women with macroprotein uria due to diabetic nephropathy. In the pregnant women with macroprot einuria, compared to the diabetic women without macroproteinuria, we o bserved both significantly higher total and percent increases in serum levels of total cholesterol (97 % versus 48 %) and of LDL-cholesterol (137 % versus 50 %), which had risen progressively throughout gestati on. The percent increases in serum triglycerides (115 % versus 128 %) were similar in both patient groups. Metabolic control was improved du ring pregnancy in both groups of women. Renal function remained normal throughout pregnancy in the diabetic women without nephropathy and wo rsened during pregnancy in the proteinuric women. The mean protein exc retion showed a physiological rise from 0.107 +/- 0.040 g 24 h-1 befor e pregnancy to 0.336 +/- 0.234 g 24 h-1 in the third trimester in the non-proteinuric women, and an increase from 2.2 +/- 1.0 to 7.1 +/- 1.7 g 24 h-1 during the same period in the women with macroproteinuria. T herefore, it is concluded that the greater increase in serum lipid lev els during pregnancy in the women with pre-existing diabetic nephropat hy can mainly be explained by the concomitant increase in proteinuria associated with development of the nephrotic syndrome in these patient s.