Pregnancy outcome in type 1 diabetic women with microalbuminuria

OBJECTIVE - To determine the influence of microalbuminuria on pregnancy out come in women with type I diabetes. RESEARCH DESIGN AND METHODS - This prospective cohort study took place at t he Obstetric Clinic at National University Hospital, Copenhagen, from Janua ry 1996 to February 2000. All Caucasian women with type I diabetes, unselec ted from the eastern part of Denmark, with a living fetus before 17 weeks o f gestation on admission were asked to participate. For women with more tha n one delivery in the study period, only the first pregnancy was included. Of the remaining 246 women, 240 (98%) entered the study. They were categori zed according to their urinary albumin excretion (normal urinary albumin ex cretion, < 30 mg/24 h; microalbuminuria, 30-300 mg/24 h; or diabetic nephro pathy, > 300 mg/24 h) before pregnancy or in the first trimester. RESULTS - A total of 203 women (85%) had normal urinary albumin excretion, 26 (11%) had microalbuminuria, and 11 (5%) had diabetic nephropathy. Mean H bA(1c) at 2-6 weeks was 7.5% (SD 1.1), 8.1 (0.9), and 8.8 (1.3) (P < 0.001) , respectively. Of all deliveries in women with normal urinary albumin excr etion, microalbuminuria, and diabetic nephropathy, 35, 62, and 91 % (P < 0. 001), respectively, were preterm, and 2, 4, and 45% (P < 0.001), respective ly were small-for-gestational-age infants. Preeclampsia developed in 6, 42, and 64% of the women (P < 0.001), respectively. Category of urinary albumi n excretion (P < 0.01) and HbA(1c) at 2-6 weeks (P < 0.05) were independent ly associated with preterm delivery. CONCLUSIONS - The prevalence of preterm delivery is considerably increased in women with microalbuminuria, mainly caused by preeclampsia. Classificati on according to urinary albumin excretion and metabolic control around the time of conception are superior to the White classification in predicting p reterm delivery in women with type 1 diabetes.