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

Abstract

Aims/hypothesis Our aim was to examine the association of White's classification with obstetric and perinatal risk factors and outcomes in type 1 diabetic patients. Methods Obstetric records of a population-based cohort of 1,094 consecutive type 1 diabetic patients with a singleton childbirth during 1988-2011 were studied. The most recent childbirth of each woman was included. Results The prepregnancy and the first trimester HbA 1c increased from White's class B to F (p for trend <0.001). Systolic and diastolic blood pressure and pre-eclampsia frequencies increased stepwise from class B to F (p for trends <0.001).Vaginal deliveries decreased and Caesarean sections and deliveries before 37 weeks increased from class B to F (p for trends <0.001). Fetal macrosomia (p for trend=0.003) decreased and small-for-gestational age infants (p for trend=0.002) and neonatal intensive care unit admissions (p for trend=0.001) increased from class B to F. In logistic regression analysis, White's classes were associated with pre-eclampsia but, with the exception of class R (proliferative retinopathy) and F (nephropathy), not with other adverse outcomes when adjusted for first trimester HbA 1c ≥7% (≥53 mmol/mol) and blood pressure ≥140/90 mmHg. First trimester HbA 1c ≥7% was associated with pre-eclampsia, preterm delivery, fetal macrosomia and neonatal intensive care unit admission. Conclusions/interpretation White's classification is useful in estimating the risk of pre-eclampsia in early pregnancy independently of suboptimal glycaemic control and hypertension. However, its utility in predicting adverse perinatal outcomes seems limited when information on first trimester HbA 1c , blood pressure and diabetic microvascular complications is available.

Well-Being and Diabetes Management in Early Pregnant Women with Type 1 Diabetes Mellitus

“…It is known that the risks of pregnancy in women with type 1 DM increase with a long duration of diabetes and occurrence of diabetes-related complications [41]. To some extent, a higher educational level and being older both positively correlated with well-being and self-efficacy in diabetes management.…”

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

“…Pregnancy-related hypertensive disorders, including preeclampsia, are leading causes of maternal and fetal morbidity and mortality worldwide [1][2][3]. Four out of ten women with pre-existing diabetes are diagnosed with a hypertensive disorder during pregnancy [2,4]. Hypertension may lead to preeclampsia, characterized by hypertension and proteinuria after 20 gestational weeks.…”

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

“…In women with type 1 diabetes, a number of risk factors for pre-eclampsia have been identified [ 8 ]. The most salient include elevated first trimester HbA 1c and both incipient and overt nephropathy [ 9 , 10 ]. Risk factors for pre-eclampsia in women with type 2 diabetes are less well studied [ 11 ].…”