Pregnancy in diabetic women who have proteinuria.

Pregnancy in diabetic women known to have proteinuria is thought to have a poor outcome. We report 22 pregnancies in 20 women with proteinuria in or before the first trimester culled from 396 diabetic pregnancies between 1974 to 1984. Despite a poor obstetric history all the present pregnancies were successful. Half were delivered before 37 weeks compared with 20 per cent of pregnancies in diabetic women without proteinuria. Hypertension precipitated two-thirds of the premature deliveries. The babies were small for dates with 65 per cent below the 50th centile, compared with 36 per cent in those without proteinuria. Serum creatinine levels were raised (greater than 150 mumol/l) in four of 19 patients in the third trimester. Since delivery one patient has died from renal failure, three have serum creatinine levels of 150 to 440 mumol/l, 11 have normal creatinine levels, and five have been lost to the study. The poor long-term maternal prognosis is an important reason for discouraging such pregnancies despite the good short-term results.