Managing diabetic nephropathy before and during pregnancy

Congenital malformations represent the major risk of pregnancy in diabetic women. Prevention needs strict glycemic control before and during pregnancy . The risk of maternal and foetal complications is particularly high among patients with diabetic nephropathy, and a multidisciplinary approach is nec essary. Before pregnancy, nephropathy is evaluated on serum creatinine and 24 hour urinary albumin and protein excretions. We discuss the interactions between diabetic nephropathy and pregnancy : the care of the other diabeti c complications, the course of renal function during and after pregnancy, t he influence of nephropathy on maternal and foetal complications and preven tion of the latter by strict control of blood pressure and glycaemia before and during pregnancy. All these elements should be taken into account when discussing pregnancy with diabetic women with nephropathy wishing to becom e pregnant. The need to take preventive measures should be emphasised but t he practice of systematically discouraging pregnancy without careful evalua tion should be avoided.