Nephrol Dial Transplant (1995) 10: 2328-2333
© 1995 European Renal Association-European Dialysis and Transplant Association
brief-report
Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome
Diabetes in Pregnancy Clinic, Perinatal Division, Departments of Obstetrics and Gynecology and Nephrology, and the Juvenile Diabetes Center, Beilinson Medical Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University Israel
Correspondence and offprint requests to: Correspondence and offprint requests to:Moshe Hod MD. Dept. of Obstetrics and Gynecology. Beilinson Medical Center. Petah Tiqva 49100. Israel
BACKGROUND: Diabetic nephropathy is associated with an increase in perinatal mortality and morbidity in uncontrolled pregnant patients. Recently angiotensin converting enzyme inhibitor (ACE-I) was shown to improve the disease status in non-pregnant subjects.
The purpose of this study was to examine the effect of prepregnancy treatment of insulin-dependent diabetes mellitus (IDDM) nephrotic women with captopril angiotensin converting enzyme inhibitor (ACE-I), on maternal renal function throughout pregnancy and on the fetomaternal outcome.
METHODS: Eight IDDM nephrotic patients planning pregnancy were treated with captopril for a minimum of 6 months prior to conception together with intensive insulin management. Conception was allowed when proteinuria was <500 mg/day and euglycaemia was achieved. At conception captopril was discontinued.
RESULTS: At the beginning of captopril treatment, proteinuria was 1633±666 mg/day. At conception, proteinuria dropped to 273±146 mg/day (P=0.0000) and increased gradually over the three trimesters to 593±515, 783±813, and 1000±1185mg/day respectively (P=0.2 between the trimesters); declining to 619±411 mg/day (P=0.0002 vs conception) 3 months after delivery. Only in two patients (25%) did proteinuria exceed 1000 mg/day during pregnancy. There was no significant change in any of the other renal function tests: CCT, serum creatinine, uric acid, K+ and blood pressure. However, there were three cases of PET just prior to delivery. Maternal glycaemic control improved significantly prior to conception (P= 0.002) and remained euglycaemic (reflected by daily glucose profile, HbA1C and fructosamine) throughout gestation. Perinatal outcome was excellent.
Keywords: angiotensin-converting enzyme inhibitor; diabetic nephropathy; pregnancy
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