Maternal overweight and obesity and risk of pre-eclampsia in women with type 1 diabetes or type 2 diabetes

Abstract

Aims/hypothesis Women with type 1 or type 2 diabetes are at increased risk of pre-eclampsia. Overweight and obesity are associated with an increased risk of pre-eclampsia in women without diabetes. The aim of the study was to investigate the impact of maternal overweight and obesity on the risk of preeclampsia in women with type 1 diabetes or type 2 diabetes. Methods In a population-based cohort study including singleton births in Sweden, we estimated the risk of pre-eclampsia among women with type 1 diabetes (n = 7062) and type 2 diabetes (n = 886), and investigated whether maternal overweight (BMI 25-29.9 kg/m 2 ) and obesity (BMI ≥30.0 kg/m 2 ) modified the risk. Logistic regression analyses were used to estimate crude and adjusted ORs with 95% CIs, using women without diabetes as the reference group (n = 1,509,525). Results Compared with women without diabetes, the adjusted ORs for pre-eclampsia in women with type 1 and type 2 diabetes were 5.74 (95% CI 5.31, 6.20) and 2.11 (95% CI 1.65, 2.70), respectively. The corresponding risks of pre-eclampsia combined with preterm birth were even higher. Risks of pre-eclampsia increased with maternal overweight (BMI 25-29.9 kg/m 2 ) and obesity (BMI ≥30.0 kg/m 2 ), foremost in women without diabetes, to a lesser extent in women with type 1 diabetes but not in women with type 2 diabetes. Conclusions/interpretation Maternal overweight and obesity increased risks of pre-eclampsia in women with type 1 diabetes but not in women with type 2 diabetes. Even so, considering associations between maternal BMI and overall maternal and offspring risk, all women (with and without diabetes) should aim for a normal weight before pregnancy.

Diabetes and Pregnancy

“…However, even women who achieve a glycated hemoglobin (A1C) ≤7.0% preconception have an increased risk of complications compared to the general population. This may be caused, in part, by maternal obesity, especially in women with type 2 diabetes (10)(11)(12)(13).…”

Diastolic blood pressure is a potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes

“…Univariate logistic regression analysis was undertaken to explore the association between preeclampsia and each of the following variables, selected based on the literature [5][6][7] : type 1 diabetes (yes/no); duration of diabetes (years); pre-pregnancy BMI (kg/m 2 ); HbA1c at first visit (%); systolic BP and diastolic BP at first visit (mmHg); nulliparity (yes/no); chronic hypertension at first visit (yes/no); retinopathy at first visit (yes/no), diabetic kidney involvement (yes/no), microangiopathy (yes/no) and preeclampsia (yes/no). To identify possible early risk factors for preeclampsia, multivariate logistic regression analysis was applied with preeclampsia as the dependent variable and the following four independent variables based on the results of the univariate analyses: nulliparity (yes/no), diabetic microangiopathy (yes/no), systolic BP and diastolic BP at first visit (per 10 mmHg).…”

“…In women with type 1 diabetes, the following factors are associated with an increased risk of developing preeclampsia: long duration of diabetes, nulliparity, obesity, diabetic kidney involvement (diabetic nephropathy or microalbuminuria), elevated BP before pregnancy, retinopathy and poor glycemic control [5][6][7][8]. Risk factors for preeclampsia in women with type 2 diabetes are less well documented [6,7].…”

Factors Associated with Placental Vascularization Measured by 3D Power Doppler Ultrasonographic Sphere Biopsy between 11 and 14 Weeks of Gestation

“…VFI is the average color value of all voxels of the studied volume, both gray and color (expressed as an absolute value: 0-100). 17 Biomarkers were transformed to obtain a normalized distribution. For each biomarker, a regression model was fitted using CRL.…”