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Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding

  • Microvascular Complications—Nephropathy (AP Maxwell, Section Editor)
  • Published:
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Abstract

In women with preexisting diabetes and nephropathy or microalbuminuria, it is important to deliver careful preconception counselling to assess the risk for the mother and the foetus, for optimizing glycaemic status and to adjust medical treatment. If serum creatinine is normal in early pregnancy, kidney function is often preserved during pregnancy, but complications such as severe preeclampsia and preterm delivery are still common. Perinatal mortality is now comparable with that in women with diabetes and normal kidney function. Besides strict glycaemic control before and during pregnancy, early and intensive antihypertensive treatment is important to optimize pregnancy outcomes. Methyldopa, labetalol, nifedipine and diltiazem are considered safe, whereas angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers should be stopped before or at confirmation of pregnancy. Supplementation with folic acid in early pregnancy and low-dose aspirin from 10 to 12 weeks reduces the risk of adverse pregnancy outcomes. During breastfeeding, several ACE inhibitors are considered safe.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ekbom P, Damm P, Feldt-Rasmussen B, Feldt-Rasmussen U, Molvig J, Mathiesen ER. Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care. 2001;24:1739–44.

    Article  CAS  PubMed  Google Scholar 

  2. Klemetti MM, Laivuori H, Tikkanen M, Nuutila M, Hiilesmaa V, Teramo K. Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011. Diabetologia. 2015;58:678–86. The largest to date population-based study of clinical care in pregnant women with type 1 diabetes and diabetic nephropathy. Hypertension management was suboptimal and severe hypertension, nephrotic proteinuria, preeclampsia and preterm delivery occurred in a high proportion of women.

    Article  CAS  PubMed  Google Scholar 

  3. Damm JA, Asbjornsdottir B, Callesen NF, Mathiesen JM, Ringholm L, Pedersen BW, et al. Diabetic nephropathy and microalbuminuria in pregnant women with type 1 and type 2 diabetes: prevalence, antihypertensive strategy, and pregnancy outcome. Diabetes Care. 2013;36:3489–94. Recent large clinical study showing that the prevalence of diabetic nephropathy and microalbuminuria in early pregnancy was similar in type 2 and type 1 diabetes and that pregnancy outcome was comparable regardless type of diabetes.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Nielsen LR, Damm P, Mathiesen ER. Improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy: effect of intensified antihypertensive therapy? Diabetes Care. 2009;32:38–44.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Landon MB. Diabetic nephropathy and pregnancy. Clin Obstet Gynecol. 2007;50:998–1006.

    Article  PubMed  Google Scholar 

  6. McCance DR, Holmes VA, Maresh MJ, Patterson CC, Walker JD, Pearson DW, et al. Vitamins C and E for prevention of pre-eclampsia in women with type 1 diabetes (DAPIT): a randomised placebo-controlled trial. Lancet. 2010;376:259–66.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Murphy HR, Steel SA, Roland JM, Morris D, Ball V, Campbell PJ, et al. Obstetric and perinatal outcomes in pregnancies complicated by Type 1 and Type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabet Med. 2011;28:1060–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Clausen TD, Mathiesen E, Ekbom P, Hellmuth E, Mandrup-Poulsen T, Damm P. Poor pregnancy outcome in women with type 2 diabetes. Diabetes Care. 2005;28:323–8.

    Article  PubMed  Google Scholar 

  9. Cundy T, Slee F, Gamble G, Neale L. Hypertensive disorders of pregnancy in women with Type 1 and Type 2 diabetes. Diabet Med. 2002;19:482–9.

    Article  CAS  PubMed  Google Scholar 

  10. Jensen DM, Damm P, Ovesen P, Molsted-Pedersen L, Beck-Nielsen H, Westergaard JG, et al. Microalbuminuria, preeclampsia, and preterm delivery in pregnant women with type 1 diabetes: results from a nationwide Danish study. Diabetes Care. 2010;33:90–4.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kitzmiller, Montoro: Diabetic Nephropathy and Pregnancy. In Managing Preexisting Diabetes and Pregnancy. Kitzmiller, Ed. American Diabetes Association, 2008, p. 374–386

  12. Mathiesen ER, Ringholm L, Feldt-Rasmussen B, Clausen P, Damm P. Obstetric nephrology: pregnancy in women with diabetic nephropathy--the role of antihypertensive treatment. Clin J Am Soc Nephrol. 2012;7:2081–8.

    Article  CAS  PubMed  Google Scholar 

  13. Piccoli GB, Clari R, Ghiotto S, Castelluccia N, Colombi N, Mauro G, et al. Type 1 diabetes, diabetic nephropathy, and pregnancy: a systematic review and meta-study. Rev Diabet Stud. 2013;10:6–26. Systematic review and meta-study on diabetic nephropathy and pregnancy in type 1 diabetes from 1980 to 2012.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bar J, Chen R, Schoenfeld A, Orvieto R, Yahav J, Ben-Rafael Z, et al. Pregnancyoutcome in patients with insulin dependent diabetes mellitus and diabetic nephropathy treated with ACE inhibitors before pregnancy. J Pediatr Endocrinol Metab. 1999;12:659–65.

    Article  CAS  PubMed  Google Scholar 

  15. Carr DB, Koontz GL, Gardella C, Holing EV, Brateng DA, Brown ZA, et al. Diabetic nephropathy in pregnancy: suboptimal hypertensive control associated with preterm delivery. Am J Hypertens. 2006;19:513–9.

    Article  PubMed  Google Scholar 

  16. Dunne FP, Chowdhury TA, Hartland A, Smith T, Brydon PA, McConkey C, et al. Pregnancy outcome in women with insulin-dependent diabetes mellitus complicated by nephropathy. QJM. 1999;92:451–4.

    Article  CAS  PubMed  Google Scholar 

  17. Gordon M, Landon MB, Samuels P, Hissrich S, Gabbe SG. Perinatal outcome and long-term follow-up associated with modern management of diabetic nephropathy. Obstet Gynecol. 1996;87:401–9.

    Article  CAS  PubMed  Google Scholar 

  18. Kimmerle R, Zass RP, Cupisti S, Somville T, Bender R, Pawlowski B, et al. Pregnancies in women with diabetic nephropathy: long-term outcome for mother and child. Diabetologia. 1995;38:227–35.

    Article  CAS  PubMed  Google Scholar 

  19. Reece EA, Coustan DR, Hayslett JP, Holford T, Coulehan J, O’Connor TZ, et al. Diabetic nephropathy: pregnancy performance and fetomaternal outcome. Am J Obstet Gynecol. 1988;159:56–66.

    Article  CAS  PubMed  Google Scholar 

  20. Reece EA, Leguizamon G, Homko C. Stringent controls in diabetic nephropathy associated with optimization of pregnancy outcomes. J Matern Fetal Med. 1998;7:213–6.

    CAS  PubMed  Google Scholar 

  21. Sorensen VR, Mathiesen ER, Heaf J, Feldt-Rasmussen B. Improved survival rate in patients with diabetes and end-stage renal disease in Denmark. Diabetologia. 2007;50:922–9.

    Article  CAS  PubMed  Google Scholar 

  22. Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003;348:2285–93.

    Article  CAS  PubMed  Google Scholar 

  23. Parving HH, Smidt UM, Hommel E, Mathiesen ER, Rossing P, Nielsen F, et al. Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy. Am J Kidney Dis. 1993;22:188–95.

    Article  CAS  PubMed  Google Scholar 

  24. Standards of medical care in diabetes--2015: summary of revisions. Diabetes Care 38 Suppl:S4, 2015

  25. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy the collaborative study group. N Engl J Med. 1993;329:1456–62.

    Article  CAS  PubMed  Google Scholar 

  26. Mathiesen ER, Hommel E, Giese J, Parving HH. Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ. 1991;303:81–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Mathiesen ER, Ronn B, Storm B, Foght H, Deckert T. The natural course of microalbuminuria in insulin-dependent diabetes: a 10-year prospective study. Diabet Med. 1995;12:482–7.

    Article  CAS  PubMed  Google Scholar 

  28. Mathiesen ER, Hommel E, Hansen HP, Smidt UM, Parving HH. Randomised controlled trial of long term efficacy of captopril on preservation of kidney function in normotensive patients with insulin dependent diabetes and microalbuminuria. BMJ. 1999;319:24–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Estacio RO, Coll JR, Tran ZV, Schrier RW. Effect of intensive blood pressure control with valsartan on urinary albumin excretion in normotensive patients with type 2 diabetes. Am J Hypertens. 2006;19:1241–8.

    Article  CAS  PubMed  Google Scholar 

  30. Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med. 2006;354:2443–51.

    Article  CAS  PubMed  Google Scholar 

  31. Tabacova S, Little R, Tsong Y, Vega A, Kimmel CA. Adverse pregnancy outcomes associated with maternal enalapril antihypertensive treatment. Pharmacoepidemiol Drug Saf. 2003;12:633–46.

    Article  CAS  PubMed  Google Scholar 

  32. Rossing K, Jacobsen P, Hommel E, Mathiesen E, Svenningsen A, Rossing P, et al. Pregnancy and progression of diabetic nephropathy. Diabetologia. 2002;45:36–41.

    Article  CAS  PubMed  Google Scholar 

  33. Bell R, Glinianaia SV, Tennant PW, Bilous RW, Rankin J. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia. 2012.

  34. Sibai: Diabetic nephropathy in pregnancy. In A practical manual of diabetes in pregnancy. Blackwell Publishing, 2008, p. 153–156

  35. Khoury JC, Miodovnik M, LeMasters G, Sibai B. Pregnancy outcome and progression of diabetic nephropathy. What’s next? J Matern Fetal Neonatal Med. 2002;11:238–44.

    Article  CAS  PubMed  Google Scholar 

  36. Clausen P, Ekbom P, Damm P, Feldt-Rasmussen U, Nielsen B, Mathiesen ER, et al. Signs of maternal vascular dysfunction precede preeclampsia in women with type 1 diabetes. J Diabetes Complications. 2007;21:288–93.

    Article  PubMed  Google Scholar 

  37. Yu Y, Jenkins AJ, Nankervis AJ, Hanssen KF, Scholz H, Henriksen T, et al. Anti-angiogenic factors and pre-eclampsia in type 1 diabetic women. Diabetologia. 2009;52:160–8.

    Article  CAS  PubMed  Google Scholar 

  38. Wang A, Rana S, Karumanchi SA: P. the role of angiogenic factors in its pathogenesis. Physiol (Bethesda ). 2009;24:147–58.

    Article  Google Scholar 

  39. Fox NS, Roman AS, Saltzman DH, Hourizadeh T, Hastings J, Rebarber A. Risk factors for preeclampsia in twin pregnancies. Am J Perinatol. 2014;31:163–6.

    PubMed  Google Scholar 

  40. Lucovnik M, Tul N, Verdenik I, Novak Z, Blickstein I. Risk factors for preeclampsia in twin pregnancies: a population-based matched case–control study. J Perinat Med. 2012;40:379–82.

    Article  PubMed  Google Scholar 

  41. Sibai BM, Hauth J, Caritis S, Lindheimer MD, Macpherson C, Klebanoff M, et al. Hypertensive disorders in twin versus singleton gestations national institute of child health and human development network of maternal-fetal medicine units. Am J Obstet Gynecol. 2000;182:938–42.

    Article  CAS  PubMed  Google Scholar 

  42. Weissgerber TL, Mudd LM. Preeclampsia and diabetes. Curr Diab Rep. 2015;15:9.

    Article  PubMed  Google Scholar 

  43. Itskovitz J, Rubattu S, Levron J, Sealey JE. Highest concentrations of prorenin and human chorionic gonadotropin in gestational sacs during early human pregnancy. J Clin Endocrinol Metab. 1992;75:906–10.

    CAS  PubMed  Google Scholar 

  44. Nielsen AH, Schauser KH, Poulsen K. Current topic: the uteroplacental renin-angiotensin system. Placenta. 2000;21:468–77.

    Article  CAS  PubMed  Google Scholar 

  45. Al KH, Nasrat H, Broughton PF. A prospective, longitudinal study of the renin-angiotensin system, prostacyclin and thromboxane in the first trimester of normal human pregnancy: association with birthweight. Hum Reprod. 2005;20:3157–62.

    Article  Google Scholar 

  46. Sealey JE, Itskovitz-Eldor J, Rubattu S, James GD, August P, Thaler I, et al. Estradiol- and progesterone-related increases in the renin-aldosterone system: studies during ovarian stimulation and early pregnancy. J Clin Endocrinol Metab. 1994;79:258–64.

    CAS  PubMed  Google Scholar 

  47. Ringholm L, Pedersen-Bjergaard U, Thorsteinsson B, Boomsma F, Damm P, Mathiesen ER. A high concentration of prorenin in early pregnancy is associated with development of pre-eclampsia in women with type 1 diabetes. Diabetologia. 2011;54:1615–9.

    Article  CAS  PubMed  Google Scholar 

  48. McDonagh TA, Robb SD, Murdoch DR, Morton JJ, Ford I, Morrison CE, et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet. 1998;351:9–13.

    Article  CAS  PubMed  Google Scholar 

  49. Tulevski II, Groenink M, van der Wall EE, van Veldhuisen DJ, Boomsma F, Stoker J, et al. Increased brain and atrial natriuretic peptides in patients with chronic right ventricular pressure overload: correlation between plasma neurohormones and right ventricular dysfunction. Heart. 2001;86:27–30.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Borghi C, Cicero AF, Degli ED, Immordino V, Bacchelli S, Rizzo N, et al. Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy. Intern Emerg Med. 2011;6:227–34.

    Article  PubMed  Google Scholar 

  51. Resnik JL, Hong C, Resnik R, Kazanegra R, Beede J, Bhalla V, et al. Evaluation of B-type natriuretic peptide (BNP) levels in normal and preeclamptic women. Am J Obstet Gynecol. 2005;193:450–4.

    Article  CAS  PubMed  Google Scholar 

  52. Ringholm L, Pedersen-Bjergaard U, Thorsteinsson B, Boomsma F, Damm P, Mathiesen ER. Atrial Natriuretic Peptide (ANP) in early pregnancy is associated with development of preeclampsia in type 1 diabetes. Diabetes Res Clin Pract. 2011;93:e106–9.

    Article  CAS  PubMed  Google Scholar 

  53. Ekbom P, Damm P, Andersson AM, Skakkebaek NE, Feldt-Rasmussen U, Mathiesen ER. Serum levels of activin A and inhibin A are not related to the increased susceptibility to pre-eclampsia in type I diabetic pregnancies. Acta Obstet Gynecol Scand. 2006;85:143–7.

    Article  CAS  PubMed  Google Scholar 

  54. Holmes VA, Young IS, Patterson CC, Maresh MJ, Pearson DW, Walker JD, et al. The role of angiogenic and antiangiogenic factors in the second trimester in the prediction of preeclampsia in pregnant women with type 1 diabetes. Diabetes Care. 2013;36:3671–7. Large assessment of the association between circulating anti-angiogenic factors and risk of preeclampsia in women with type 1 diabetes.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  55. Maynard SE, Karumanchi SA. Angiogenic factors and preeclampsia. Semin Nephrol. 2011;31:33–46.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  56. Holmes VA, McCance DR. Could antioxidant supplementation prevent pre-eclampsia? Proc Nutr Soc. 2005;64:491–501.

    Article  CAS  PubMed  Google Scholar 

  57. McCance DR, Holmes VA, Maresh MJ, Patterson CC, Walker JD, Pearson DW, et al. Vitamins C and E for prevention of pre-eclampsia in women with type 1 diabetes (DAPIT): a randomised placebo-controlled trial. Lancet. 2010;376:259–66.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  58. Biesenbach G, Stoger H, Zazgornik J. Influence of pregnancy on progression of diabetic nephropathy and subsequent requirement of renal replacement therapy in female type I diabetic patients with impaired renal function. Nephrol Dial Transplant. 1992;7:105–9.

    CAS  PubMed  Google Scholar 

  59. Purdy LP, Hantsch CE, Molitch ME, Metzger BE, Phelps RL, Dooley SL, et al. Effect of pregnancy on renal function in patients with moderate-to-severe diabetic renal insufficiency. Diabetes Care. 1996;19:1067–74.

    Article  CAS  PubMed  Google Scholar 

  60. Ringholm L, Mathiesen ER, Kelstrup L, Damm P. Managing type 1 diabetes mellitus in pregnancy--from planning to breastfeeding. Nat Rev Endocrinol. 2012;8:659–67.

    Article  CAS  PubMed  Google Scholar 

  61. Boulot P, Chabbert-Buffet N, d’Ercole C, Floriot M, Fontaine P, Fournier A, et al. French multicentric survey of outcome of pregnancy in women with pregestational diabetes. Diabetes Care. 2003;26:2990–3.

    Article  PubMed  Google Scholar 

  62. Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ. 2004;328:915.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Ekbom P, Damm P, Nogaard K, Clausen P, Feldt-Rasmussen U, Feldt-Rasmussen B, et al. Urinary albumin excretion and 24-hour blood pressure as predictors of pre-eclampsia in Type I diabetes. Diabetologia. 2000;43:927–31.

    Article  CAS  PubMed  Google Scholar 

  64. Hanson U, Persson B. Epidemiology of pregnancy-induced hypertension and preeclampsia in type 1 (insulin-dependent) diabetic pregnancies in Sweden. Acta Obstet Gynecol Scand. 1998;77:620–4.

    Article  CAS  PubMed  Google Scholar 

  65. Holmes VA, Young IS, Patterson CC, Pearson DW, Walker JD, Maresh MJ, et al. Optimal glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes in the diabetes and pre-eclampsia intervention trial. Diabetes Care. 2011;34:1683–8.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Hiilesmaa V, Suhonen L, Teramo K. Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with type I diabetes mellitus. Diabetologia. 2000;43:1534–9.

    Article  CAS  PubMed  Google Scholar 

  67. Guerin A, Nisenbaum R, Ray JG. Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with prepregnancy diabetes. Diabetes Care. 2007;30:1920–5.

    Article  CAS  PubMed  Google Scholar 

  68. Jensen DM, Korsholm L, Ovesen P, Beck-Nielsen H, Moelsted-Pedersen L, Westergaard JG, et al. Peri-conceptional A1C and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes. Diabetes Care. 2009;32:1046–8.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, Johansen M, Damm P, Mathiesen ER. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care. 2008;31:9–14.

    Article  PubMed  Google Scholar 

  70. Secher AL, Mathiesen ER, Andersen HU, Peter D, Lene R. Severe hypoglycemia in pregnant women with type 2 diabetes-A relevant clinical problem. Diabetes Res Clin Pract. 2013;102:e17–8.

    Article  PubMed  Google Scholar 

  71. Management of diabetes from preconception to the postnatal period. summary of NICE guidance. BMJ. 2008;336:714–7.

    Article  Google Scholar 

  72. Lauszus FF, Gron PL, Klebe JG. Pregnancies complicated by diabetic proliferative retinopathy. Acta Obstet Gynecol Scand. 1998;77:814–8.

    Article  CAS  PubMed  Google Scholar 

  73. Vestgaard M, Ringholm L, Laugesen CS, Rasmussen KL, Damm P, Mathiesen ER. Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes. Diabet Med. 2010;27:431–5.

    Article  CAS  PubMed  Google Scholar 

  74. Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010;116:402–14.

    Article  PubMed  Google Scholar 

  75. Duley L, Henderson-Smart DJ, Meher S, King JF: Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev CD004659, 2007

  76. Catalano, Conway: Management of pregnancy complications. In Managing preexisting diabetes and pregnancy. 2008, p. 578–584

  77. Wilson RD, Davies G, Desilets V, Reid GJ, Summers A, Wyatt P, et al. The use of folic acid for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can. 2003;25:959–73.

    PubMed  Google Scholar 

  78. Capel I, Corcoy R. What dose of folic acid should be used for pregnant diabetic women? Diabetes Care. 2007;30:e63.

    Article  PubMed  Google Scholar 

  79. Kazmin A, Garcia-Bournissen F, Koren G. Risks of statin use during pregnancy: a systematic review. J Obstet Gynaecol Can. 2007;29:906–8.

    PubMed  Google Scholar 

  80. Bullo M, Tschumi S, Bucher BS, Bianchetti MG, Simonetti GD. Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists: a systematic review. Hypertension. 2012;60:444–50.

    Article  CAS  PubMed  Google Scholar 

  81. Porta M, Hainer JW, Jansson SO, Malm A, Bilous R, Chaturvedi N, et al. Exposure to candesartan during the first trimester of pregnancy in type 1 diabetes: experience from the placebo-controlled DIabetic REtinopathy Candesartan Trials. Diabetologia. 2011;54:1298–303.

    Article  CAS  PubMed  Google Scholar 

  82. Tennant PW, Glinianaia SV, Bilous RW, Rankin J, Bell R. Should women with diabetic nephropathy considering pregnancy continue ACE inhibitor or angiotensin II receptor blocker therapy until pregnancy is confirmed? Reply to Lewis G and Maxwell AP [letter]. Diabetologia. 2014;57:1084–5.

    Article  PubMed  Google Scholar 

  83. Nielsen LR, Muller C, Damm P, Mathiesen ER. Reduced prevalence of early preterm delivery in women with Type 1 diabetes and microalbuminuria--possible effect of early antihypertensive treatment during pregnancy. Diabet Med. 2006;23:426–31.

    Article  CAS  PubMed  Google Scholar 

  84. Khandelwal M, Kumanova M, Gaughan JP, Reece EA. Role of diltiazem in pregnant women with chronic renal disease. J Matern Fetal Neonatal Med. 2002;12:408–12.

    Article  CAS  PubMed  Google Scholar 

  85. Magee LA, Ornstein MP, Von DP. Fortnightly review: management of hypertension in pregnancy. BMJ. 1999;318:1332–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  86. Colstrup M, Mathiesen ER, Damm P, Jensen DM, Ringholm L. Pregnancy in women with type 1 diabetes: have the goals of St. Vincent declaration been met concerning foetal and neonatal complications? J Matern Fetal Neonatal Med. 2013;26:1682–6. Review of all population-based studies published within the last 10 years comparing pregnancy outcomes in women with T1DM and women from the background population.

    Article  CAS  PubMed  Google Scholar 

  87. Pedersen BW, Ringholm L, Damm P, Tabor A, Sogaard K, Hellmuth E, Mathiesen ER: Stable fetal hemodynamics measured by Doppler flow after initiation of anti-hypertensive treatment with methyldopa in pregnant women with diabetes. J Matern Fetal Neonatal Med 14, 2015. First study to document the safety of initiating antihypertensive treatment in late pregnancy on fetal outcomes.

  88. Folic MM, Jankovic SM, Varjacic MR, Folic MD. Effects of methyldopa and nifedipine on uteroplacental and fetal hemodynamics in gestational hypertension. Hypertens Pregnancy. 2012;31:31–9.

    Article  CAS  PubMed  Google Scholar 

  89. Montan S, Anandakumar C, Arulkumaran S, Ingemarsson I, Ratnam SS. Effects of methyldopa on uteroplacental and fetal hemodynamics in pregnancy-induced hypertension. Am J Obstet Gynecol. 1993;168:152–6.

    Article  CAS  PubMed  Google Scholar 

  90. Montan S, Anandakumar C, Arulkumaran S, Ingemarsson I, Ratnam S. Randomised controlled trial of methyldopa and isradipine in preeclampsia--effects on uteroplacental and fetal hemodynamics. J Perinat Med. 1996;24:177–84.

    Article  CAS  PubMed  Google Scholar 

  91. Von DP, Ornstein MP, Bull SB, Logan AG, Koren G, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Lancet. 2000;355:87–92.

    Article  Google Scholar 

  92. American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 1994;93:137–50.

    Google Scholar 

  93. Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy. 2002;21:85–95.

    Article  CAS  PubMed  Google Scholar 

  94. Shannon ME, Malecha SE, Cha AJ. Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and lactation: an update. J Hum Lact. 2000;16:152–5.

    Article  CAS  PubMed  Google Scholar 

  95. Podymow T, August P. Antihypertensive drugs in pregnancy. Semin Nephrol. 2011;31:70–85.

    Article  CAS  PubMed  Google Scholar 

  96. Shannon ME, Malecha SE, Cha AJ. Beta blockers and lactation: an update. J Hum Lact. 2000;16:240–5.

    Article  CAS  PubMed  Google Scholar 

  97. Podymow T, Joseph G. Preconception and pregnancy management of women with diabetic nephropathy on angiotensin converting enzyme inhibitors. Clin Nephrol. 2015;83:73–9.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Lene Ringholm.

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Lene Ringholm, Julie Agner Damm, Marianne Vestgaard, Peter Damm and Elisabeth R. Mathiesen declare that they have no conflict of interest.

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This article contains studies with human subjects performed by all authors. The studies have been approved by the appropriate national research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

This article does not contain any studies with animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Microvascular Complications—Nephropathy

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Ringholm, L., Damm, J.A., Vestgaard, M. et al. Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding. Curr Diab Rep 16, 12 (2016). https://doi.org/10.1007/s11892-015-0705-3

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