medwireNews: Women with type 1 diabetes who have microalbuminuria at the time of pregnancy have an increased risk for adverse pregnancy outcomes in the short term and for diabetes complications in the long term, shows research presented at the 58th EASD Annual Meeting in Stockholm, Sweden.
The study cohort of 191 women with type 1 diabetes at the time of their first pregnancy included 75 who had microalbuminuria. These women had similar diabetes duration and glycemic control to those with normoalbuminuria at baseline, but 18.6% versus just 6.8% had retinopathy when examined during the first trimester.
During the third trimester, the rates of macroalbuminuria and retinopathy were significantly higher among women with baseline microalbuminuria compared with those who had normoalbuminuria, at 14.6% versus 2.4% and 20.0% versus 8.6%, respectively.
Moreover, women with microalbuminuria had a significantly higher rate of preterm delivery than those without, at 14.6% versus 5.1%, and a trend toward higher rates of preeclampsia (8.0 vs 1.7%) and perinatal death (6.6 vs 0.5%). They also had significantly higher rates of neonatal hypoglycemia, at 10.6% versus 5.1%, and neonatal respiratory distress syndrome, at 14.6% versus 3.4%.
Presenter Natalia Asatiani (National Center for Diabetes Research, Tbilisi, Georgia) explained that the researchers re-examined the women 6 and 13 years after delivery, looking specifically at retinopathy and kidney disease. After 13 years, the average glycated hemoglobin level increased in both groups, from approximately 6% (42 mmol/mol) at baseline, to reach an average of 7.70% (61 mmol/mol) in the normoalbuminuria group and 8.05% (64 mmol/mol) in the microalbuminuria group.
The pattern of significantly poorer outcomes in women with microalbuminuria at the time of pregnancy continued. At 13 years, the rate of retinopathy was 50.6% in these women, compared with 14.6% in those with normoalbuminuria, and the corresponding rates of macroalbuminuria were 32.0% versus 10.3%.
Among women who developed macroalbuminuria, the rates of stage 3, 4, and 5 chronic kidney disease were 30.6%, 38.8%, and 18.4%, respectively, while 5.5% required a kidney transplant and 5.5% died.
Asatiani stressed, however, that the occurrences of kidney transplant and death were around 10 years ago, noting that in more recent years they have had good results treating similar patients with newer medications such as dapagliflozin.
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