Reece E A, Leguizamon G, Homko C
Department of Obstetrics, Gynecology and Reproductive Science, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Am J Perinatol. 1998 Jul;15(7):413-21. doi: 10.1055/s-2007-993968.
The purpose of the current study is to report the effect of diabetic nephropathy on pregnancy outcomes based on a review of the world's literature from 1981 to 1996. In addition, the effects of pregnancy on renal function in a select subpopulation of patients is also presented. The Medline Computer System was used to survey the English language literature on diabetic nephropathy complicating pregnancy between 1981 and 1996, which yielded a total patient population of 315. The database was analyzed according to patient population, clinical management, maternal complications and outcomes, and fetal complications and outcomes. The frequency of chronic hypertension was 42% with 60% of women manifesting hypertension by the third trimester. Pre-eclampsia developed in 41% of patients; proliferative retinopathy was observed in 63% of patients prior to pregnancy, and cesarean section delivery was performed in 74% of the patients. Among the fetal outcomes, intrauterine growth restriction (IUGR) was observed in 15%, preterm delivery in 22%, and major congenital malformations in 8% of the patients included in the database. The observed overall perinatal morality rate was 5%. Gestational age at delivery was significantly correlated with first-trimester Cr/Cl (p < 0.01), third-trimester Cr/Cl (p < 0.05), third trimester proteinuria (p < 0.01), and third-trimester blood pressure (p < 0.001). Birth weight was significantly correlated with first-trimester Cr/Cl (p < 0.01), third-trimester Cr/Cl (p < 0.001), third-trimester proteinuria (p < 0.01), and third-trimester blood pressure (p < 0.001). Of the 185 patients available for long-term follow-up (mean 35 months), 17% developed end-stage renal disease, and 5% died as a result of renal insufficiency. Among the renovascular parameters, proteinuria and mean arterial pressure significantly increased from the first to the third trimester (p < 0.05). When these parameters were evaluated at follow-up, blood pressure did not show a significant increase from first trimester values, however, proteinuria did show a weak, but significant, increase postpartum. These data suggest that with contemporary methods of perinatal care, fetal survival rates of 95% are achievable in diabetic women with nephropathy. Furthermore, although many women experienced a temporary decline in renal function during gestation, pregnancy per se, does not appear to worsen the natural progression to end-stage renal disease for most women with renal insufficiency.
本研究旨在通过回顾1981年至1996年的世界文献，报告糖尿病肾病对妊娠结局的影响。此外，还介绍了妊娠对特定亚组患者肾功能的影响。使用Medline计算机系统检索1981年至1996年间关于糖尿病肾病合并妊娠的英文文献，共纳入315例患者。根据患者人群、临床管理、母亲并发症及结局、胎儿并发症及结局对数据库进行分析。慢性高血压的发生率为42%，60%的女性在孕晚期出现高血压。41%的患者发生子痫前期；63%的患者在妊娠前观察到增殖性视网膜病变，74%的患者进行了剖宫产。在胎儿结局方面，数据库中的患者有15%出现宫内生长受限（IUGR），22%早产，8%有严重先天性畸形。观察到的围产期总死亡率为5%。分娩时的孕周与孕早期肌酐清除率（Cr/Cl）显著相关（p<0.01）、孕晚期Cr/Cl（p<0.05）、孕晚期蛋白尿（p<0.01）和孕晚期血压（p<0.001）。出生体重与孕早期Cr/Cl（p<0.01）、孕晚期Cr/Cl（p<0.001）、孕晚期蛋白尿（p<0.01）和孕晚期血压（p<0.001）显著相关。在185例可进行长期随访的患者中（平均35个月），17%发展为终末期肾病，5%因肾功能不全死亡。在肾血管参数中，蛋白尿和平均动脉压从孕早期到孕晚期显著升高（p<0.05）。在随访时评估这些参数时，血压与孕早期值相比没有显著升高，然而，蛋白尿在产后确实有微弱但显著的升高。这些数据表明，采用当代围产期护理方法，肾病糖尿病女性的胎儿存活率可达95%。此外，尽管许多女性在妊娠期间肾功能出现暂时下降，但对于大多数肾功能不全的女性来说，妊娠本身似乎并不会使向终末期肾病的自然进展恶化。
