A Case of Pregnant Woman With Preexisting Type 2 Diabetes and Severe Diabetic Nephropathy Having Safely Given Birth by Multidisciplinary Therapy

Abstract

A thirty-nine-year-old woman with a 20-year history of type 2 diabetes mellitus was admitted to our hospital because of her spontaneous pregnancy at 7 weeks of gestation. As she had severe diabetic nephropathy (serum creatinine, 1.66 mg/dL; estimated glomerular filtration rate, 29 mL/min/1.73 m²), she had been advised to avoid pregnancy. In spite of the high risk of perinatal complications, she strongly desired to continue the pregnancy. Her blood glucose and blood pressure were carefully controlled with hospitalization and outpatient care. At 34 weeks of gestation, her renal function deteriorated (serum creatinine, 2.35 mg/dL; estimated glomerular filtration rate, 20 mL/min/1.73 m²), she also complained blurred vision, and the fetus showed signs of growth retardation. A baby boy of 1712 g in body weight was delivered by caesarean section. The neonate was hypoglycemic, but free of deformation. Multidisciplinary treatment and management are necessary for pregnant women with severe diabetic nephropathy.