糖尿病肾病合并妊娠研究进展

Research progress on diabetic nephropathy complicated with pregnancy

在世界范围内,妊娠期糖尿病孕妇的数量一直在稳步增加。这些妊娠会增加各种并发症的风险,包括流产、先天性畸形、巨大儿、胎儿生长受限、子痫前期、早产和死产。对于患有糖尿病肾病的孕妇来说,评估妊娠对肾功能的影响以及肾病对妊娠结局的影响是很重要的。肾功能和微量白蛋白尿正常的孕妇在怀孕期间肾功能丧失的风险较低,而肾小球滤过率<60 ml/min和/或蛋白尿≥3 g/24 h的孕妇在怀孕初期就有永久性肾脏损害的风险。胎儿和母亲并发症的风险与慢性肾脏疾病的严重程度和血糖控制相关。产前护理的进步改善了胎儿和产妇的结局。孕前咨询已成为所有糖尿病妇女,特别是糖尿病和慢性肾病妇女成功怀孕的关键。

The number of pregnant women with gestational diabetes has been steadily increasing worldwide.These pregnancies have elevated risk of various complications,including miscarriage,congenital abnormalities,macrosomia,fetal growth restriction,preeclampsia,preterm birth,and stillbirth.For pregnant women with diabetic nephropathy,it is crucial to assess the impact of pregnancy on kidney function and the influence of kidney disease on pregnancy outcomes.Pregnant women with normal kidney function and microalbuminuria have lower risk of kidney function loss during pregnancy,whereas those with a glomerular filtration rate<60 ml/min and/or proteinuria≥3 g/24 h in early pregnancy face risk of permanent kidney damage.The risk of complications for both the fetuses and mothers is associated with the severity of chronic kidney disease and glycemic control.Advancements in prenatal care have improved outcomes for both the fetuses and mothers.Preconception counseling has become a critical factor for the successful pregnancy of all diabetic women,especially those with diabetes and chronic kidney disease.