Diabetes and Pregnancy Outcomes

The prevalence of diabetes in pregnant women is increasing. Gestational diabetes may predispose women to early-stage kidney damage which may have consequences on pregnancy outcomes.

Researchers at the Department of Perinatal Medicine, Mercy Health Heidelberg, Australia have found in a new study that pregnant women with diabetes and low kidney function were at high risk of developing pregnancy complications like preeclampsia and preterm birth.

The findings of the research have been published in the journal Diabetes Research and Clinical Practice.

Gestational diabetes may predispose women to early-stage kidney damage, a precursor to chronic kidney disease, but its link to pregnancy outcomes was explored by the researchers.

The researchers conducted an observational study to evaluate the association between maternal renal function and pregnancy outcomes in type 1 and type 2 diabetes. They investigated the prognostic value of estimated glomerular filtration rate (eGFR) and albuminuria in determining pregnancy outcomes in women with diabetes.

An observational study of pregnant women with type 1 (n = 92) and type 2 diabetes (n = 106) who delivered between 2004 and 2014 at a single tertiary obstetric centre was conducted. Clinical and biochemical characteristics were determined and related to major obstetric outcomes:

• Preeclampsia
• Preterm birth <32 and <37 weeks
• Neonatal intensive care admission

We used univariate analyses and multivariable logistic regression models with eGFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and albuminuria as covariates.

In the pooled diabetes cohort, multivariable logistic regression with eGFR and albuminuria status demonstrated that the presence of albuminuria (albumin-to-creatinine ratio ≥3.5 mg/mmol) (OR, 2.7; 95% CI, 1.42-4.99; P = 0.002) was associated with preeclampsia, whilst an eGFR of <120 mL/min/1.73m² was associated with preterm birth <32 weeks (OR, 1.04; 95% CI, 1.00-1.09; P = 0.02).

The researchers concluded that despite its recognized limitations in pregnancy, lower estimated glomerular filtration rate values were associated with increased risk of adverse outcomes. Our exploratory data suggest eGFR, along with albuminuria, can aid in identifying women at high risk of developing adverse obstetric outcomes.

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