INTRAUTERINE DIABETES EXPOSURE AND THE RISK OF RENAL-DISEASE IN DIABETIC PIMA-INDIANS

The association between the diabetic intrauterine environment and rena l disease was examined cross-sectionally in 503 Pima Indians with type 2 diabetes. Subjects were selected from participants in an ongoing st udy of diabetes and its complications in the Gila River Indian Communi ty of Arizona. Subjects' exposure to diabetes in utero was established from periodic examinations conducted as part of the study. The preval ence of elevated urinary albumin excretion (UAE) (albumin-to-creatinin e ratio greater than or equal to 30 mg/g) was 40% (83 of 207) in the o ffspring of nondiabetic mothers, 43% (105 of 246) in the offspring of prediabetic mothers (i.e., women who were not diabetic at the time of the pregnancy but who developed diabetes after the pregnancy), and 58% (29 of 50) in the offspring of mothers who had diabetes during pregna ncy. After controlling for age, sex, duration of diabetes, HbA(1c), an d mean arterial pressure in the offspring in a logistic regression ana lysis using generalized estimating equations, maternal diabetes during pregnancy was strongly associated with elevated UAE. The odds of elev ated UAE in the offspring of mothers who had diabetes during pregnancy was 3.8 times (95% CI 1.7-8.4) that of the offspring of prediabetic m others; the odds of elevated UAE in the offspring of nondiabetic and p rediabetic mothers were similar (odds ratio of 0.94; 95% CI 0.59-1.5). We concluded that exposure to a diabetic intrauterine environment inc reases the risk of elevated UAE in diabetic Pima Indians. The effect o f this exposure appears to be independent of other susceptibility fact ors that lead to nephropathy in diabetes.