Kohortenstudie zum prognostischen Stellenwert von Nierenfunktionsparametern bei Risikoschwangerschaften (Hypertonie, Diabetes mellitus Typ 1, Gestationsdiabetes)

Abstract

Introduction: The aim of the study was to compare perinatal outcomes, urinary and renal parameters between healthy pregnant women, and pregnant women with prexisting diabetes mellitus, gestational diabetes and pregnancy-induced hypertension. Research Design and Methods: During the second and the third trimenon, urinary proteins were analysed in 97 unselected pregnant women who attended a university hospital outpatient clinic in Germany as part of their routine clinical care (21 healthy pregnant women [NK], 31 women with gestational diabetes [GDM], 10 women with type 1 diabetes [DM1], 35 women with pregnancy-induced hypertension [PIH]). Results: Urinary parameters: In women with PIH mean serum albumin was lower compared with NK, but urinary creatinine, al-microglobulin, microalbuminuria, uric acid and albumin-creatinine ratio were higher in PIH. In women with type 1 and gestational diabetes serum albumin was lower than in NK but there was no difference in urinary creatinine. Albumin/creatinine-ratio was higher in women with DM1 and GDM. Microalbuminuria was higher in DM1 compared to NK. There were two cases of neonatal death (PIH group) and a trend to preterm delivery in the PIH, DM1 and GDM group. Low birth weight was more frequent in women with DM1. The rate of fetal metabolic acidosis and pre-acidosis was higher in women with GDM. Conclusion: There is a close relationship between urinary parameters, diabetes and hypertension during pregnancy. Micro-albuminuria, urinary α1-microglobulin and albumin/creatinine ratio seem to be especially important. The increase in urinary albumin and α1-microglobulin excretion suggests glomerular as well as tubular injury in this group of risk pregnancies. However, there was no statistically significant relationship between urinary parameters and perinatal outcomes which could be due to effective care in a tertiary university center. Nevertheless, urinary parameters could be helpful to diagnose earlier renal injuries in women with risk pregnancies.