Pregnancy outcome in patients with insulin dependent diabetes mellitus anddiabetic nephropathy treated with ACE inhibitors before pregnancy

The preconception and intrapregnancy parameters that are relevant to outcom e in women with insulin dependent diabetes mellitus (IDDM) and diabetic nep hropathy remain controversial. We analyzed the types and frequencies of mat ernal and neonatal complications in 24 IDDM patients with diabetic nephropa thy (24 pregnancies), all with preserved to mildly impaired renal function. All patients received treatment with captopril for at least six months pri or to planned pregnancy and were maintained under strict glycemic control f rom at least three months before pregnancy to delivery. A successful pregna ncy outcome (live, healthy infant without severe handicaps two years after delivery) was observed in 87.5% of the patients. Preexisting hypertension w as the only parameter found to be significantly predictive of an unsuccessf ul outcome (p=0.0004). We conclude that in patients with IDDM complicated b y diabetic nephropathy, pre-pregnancy captopril treatment combined with str ict glycemic control offers a prolonged protective effect against possible renal deterioration and probably improves pregnancy outcome.