Abstract
INTRODUCTION: The prevalence of diabetes mellitus (DM) has increased tremendously in the last two decades mainly due to the pandemic of obesity. Diabetes is a well-known cause of complications during pregnancy. Diabetic nephropathy (DN) is a marker of severe diabetes and resultant organ damage. Despite that, only small studies have evaluated the implications of DN on pregnancy complications. The objective of this study was to explore the effect of nephropathy on obstetric and perinatal outcomes among women with DM using a population database. METHODS: This was a retrospective cohort study utilizing data from the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample including women who delivered between 2004 and 2014. Multivariate logistic regression was used to control for confounding effects. RESULTS: Among 86,615 pregnancies that were complicated by DM, 1,241 (1.4%) had DN. Women with DN were more likely to smoke during pregnancy; have chronic hypertension, neuropathy, retinopathy, peripheral circulatory disorders, and thyroid diseases; and experience diabetic ketoacidosis compared to diabetic patients without nephropathy (all P <0.05). After adjusting for confounding factors, DN was associated with preeclampsia (aOR, 2.26; 95% CI, 1.90–2.68), superimposed preeclampsia or eclampsia (aOR, 4.21; 95% CI, 3.53–5.01), preterm birth (aOR, 1.83; 95% CI, 1.59–2.1), and blood transfusion (aOR, 3.55; 95% CI, 2.82–4.46). CONCLUSION: DN is associated with increased obstetric and perinatal morbidity than DM alone. These patients may benefit from vigilant antenatal surveillance, rigorous screening and prevention methods for hypertensive disorders and delivery in a tertiary-care center.