Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

Abstract

It has long been known that Type I (insulin-dependent) diabetes mellitus considerably increases the risk of pre-eclampsia and maternal and fetal co-morbidity [1±3]. The most important risk factor of pre-eclampsia in women with diabetes is nephropathy (White's class F) [1]. Even incipient nephropathy substantially increases the risk [4]. In addition, retinopathy and long duration of diabetes also increase the risk of pre-eclampsia [5±8].Although an association between poor glycaemic control in early pregnancy and pre-eclampsia has been reported [4, 7±11], it has not been observed by all [12]. It is not clear to what extent glycaemic control in early pregnancy might exert an effect on the occurrence of pre-eclampsia. Diabetic women with HbA 1 c values greater than 8 % could be at a greater risk of pre-eclampsia than those with values less than 8 % [10]. It is not known whether the risk of pre-eclampsia in diabetic women with relatively good gly- Abstract Aims/hypothesis. To investigate the association between glycaemic control and hypertensive pregnancy complications. Methods. From 1988 to 1997, we followed up 683 consecutive non-selected pregnancies in women with Type I (insulin-dependent) diabetes mellitus. Glycaemic control was assessed by assay of HbA 1 c . Pre-eclampsia was defined as diastolic blood pressure of 90 mmHg or more at the end of pregnancy after an increase of 15 mmHg or more, combined with proteinuria of 0.3 g or more for 24 h. Pregnancy-induced hypertension was defined similarly but without proteinuria. The same criteria were applied to a control group of 854 non-selected non-diabetic women. Results. Pre-eclampsia developed in 12.8 % of the women with diabetes (excluding those with nephropathy before pregnancy) and in 2.7 % of the control women (odds ratio 5.2; 95 % CI 3.3±8.4). In multiple logistic regression, glycaemic control, nulliparity, retinopathy and duration of diabetes emerged as statistically significant independent predictors of pre-eclampsia. The adjusted odds ratios for pre-eclampsia were 1.6 (95 % CI 1.3±2.0) for each 1 % increment in the HbA 1 c value at 4±14 (median 7) weeks of gestation and 0.6 (0.5±0.8) for each 1 % decrement achieved during the first half of pregnancy. Changes in glycaemic control during the second half of pregnancy did not significantly alter the risk of pre-eclampsia. Unlike pre-eclampsia, the risk of pregnancy-induced hypertension was not associated with glycaemic control. Conclusion/interpretation. In women with Type I diabetes, poor glycaemic control is associated with an increased risk of pre-eclampsia but not with a risk of pregnancy-induced hypertension. [Diabetologia (2000

A high concentration of prorenin in early pregnancy is associated with development of pre-eclampsia in women with type 1 diabetes

“…Although the number of women with preeclampsia in this observational study is too small for firm conclusions, a combined effect of improved glycaemic control and early intensive antihypertensive intervention may explain the lower proportion of women with preeclampsia as compared with previous reports of preeclampsia in approximately 13% of diabetic women [10].…”

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

“…Previous studies have reported similar increasing rates of pre-eclampsia with increasing severity of diabetes according to White's classification [12,13,30,31]. Our results suggest that the association of White's class with pre-eclampsia is possibly even more pronounced than that of suboptimal glycaemic control and chronic hypertension, which are established risk factors of pre-eclampsia in diabetic pregnancies [21,31,32].…”

Poor Pregnancy Outcome in Women With Type 2 Diabetes

“…In women with type 1 diabetes who do not have diabetic nephropathy, it is well documented that the best predictor of poor pregnancy outcome is high HbA 1c early in pregnancy as well as an inappropriate reduction in HbA 1c during pregnancy (15)(16)(17)(18). In concordance with this, the HbA 1c levels were significantly elevated in pregnancies in women with type 2 diabetes during the entire pregnancy compared with the normal range.…”