A 31-year-old woman with diabetic nephropathy (baseline proteinuria 2 g/day) seeks preconception advice. Which single parameter best predicts a favourable versus adverse maternal and fetal outcome if she conceives?
- A Degree of proteinuria alone
- B Pre-pregnancy serum creatinine, with values above approximately 1.4 mg/dL predicting poor outcome ✓
- C Duration of diabetes irrespective of renal function
- D Presence of retinopathy
Correct answer: B. Pre-pregnancy serum creatinine, with values above approximately 1.4 mg/dL predicting poor outcome
Explanation
In diabetic nephropathy complicating pregnancy, pre-pregnancy renal function is the strongest predictor: with a serum creatinine below about 1.4 mg/dL (125 micromol/L), outcomes are generally acceptable, whereas higher values predict accelerated decline in maternal renal function, worsening hypertension, preterm birth and fetal growth restriction. Proteinuria and retinopathy accompany advanced disease but do not supersede creatinine as the discriminating variable, and duration of diabetes matters mainly through its effect on renal function.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.