August 16, 2002
Complications, Family Planning
Question from Reston, Virginia, USA:
I have had type 1 diabetes for 20 years, and about a month before I found out I was pregnant four years ago, I found out that I had protein in my urine. During the pregnancy the protein got progressively worse, and I had a healthy baby. At the end of the pregnancy, I had about 2 grams of protein in my urine and have been on an ACE inhibitor ever since.
For the past two and a half years, I have had undetectable amounts of protein in my urine, I have no signs of retinopathy, and my hemoglobin A1c has been in the 6.5 and 6.7% range.I would like to have another pregnancy, but I know that I will have to go off the ACE inhibitor. Will my protein go right back up to 2 grams immediately? Will it take longer to get worse because it has been fine for several years? If I have a pregnancy can I go straight back on the ACE inhibitors and bring the protein back to normal again?
Answer:
I cannot say exactly what will happen with your kidneys. You have some degree of nephropathy which is being treated by the ACE inhibitor. Discontinuing this medication may result in return of the protein. How quickly or how much is unpredictable.
From what I have read in the medical literature, pregnancy does not appear to accelerate kidney disease beyond the normal rate associated with diabetes, but you will be at increased risk for preeclampsia. I would suggest asking your endocrinologist to do a kidney evaluation (creatinine clearance and protein quantification) prior to conception to determine what your baseline is. You should also be consulting with a high risk pregnancy specialist as well. With proper attention you should be able to get through a pregnancy without too much difficulty.
OWJ
