Pregnancy outcome in women with insulin-dependent diabetes mellitus complicated by nephropathy

We retrospectively analysed pregnancy complicated by diabetic nephropathy i n patients attending a University teaching hospital (1990-97), to examine f etal/maternal outcomes. Fetal outcomes included early intrauterine deaths, stillbirths, neonatal/perinatal mortality, size for gestational age, malfor mations, and need for neonatal unit care. Maternal outcomes included change in frequency of hypertension or severe proteinuria, serum creatinine data, and caesarean section rate. There were 21 pregnancies in 18 women, resulti ng in 21 live infants. Neonatal mortality (RR 10, 95%CI 0-3.9), perinatal m ortality (RR 5, 95%CI 0-3.3) and congenital malformations (RR 5.0 95%CI 0.3 -26.3) were greater than in the background population. At delivery, 76% of babies were appropriate in size for gestational age; 57% were preterm, all of whom required neonatal unit care. The caesarean section rate was 90.5% v s. 20% in the background population (RR 4.5, 95%CI 3.4-5.0) (p<0.05). Hyper tension frequency (p<0.001) and high-grade proteinuria (p<0.05) increased f rom booking to delivery. Although the take-home baby rate was 90%, perinata l/neonatal mortality, congenital malformations and caesarean sections, in a ddition to maternal morbidity, were significantly higher in women with diab etic nephropathy than in the background population.