Preeclampsia in women with pregestational diabetes – a cohort study

ABSTRACT

Aims: To evaluate risk factors for preeclampsia (PE) in women with pregestational diabetes.

Methods: Retrospective cohort study of women with pregestational diabetes cared for at a specialized prenatal care facility. Maternal characteristics at booking and during pregnancy were studied for their association with preeclampsia. Multivariable models were tested using Poisson regression with robust estimates; results were expressed as relative risk (RR) and 95% confidence interval (CI).

Results: Preeclampsia was diagnosed in 62 of 206 women (30%, 95% CI 24–37%). Previous chronic hypertension was found in 53 subjects (26%; 95% CI 20–32%), of whom 41 (77%, 95% CI 64–88) were type 2 women. Type 1 diabetes, chronic hypertension, systolic blood pressure >124 mmHg at booking and gestational weight gain, either total or excessive for body mass index category, behaved as independent risk factors.

Conclusions: In women with pregestational diabetes, some risk factors may predict PE, similar to those found in non-diabetic pregnant women. Two non-modifiable factors (type of diabetes and chronic hypertension) and two modifiable ones (systolic blood pressure levels and gestational weight gain) were found relevant in this cohort. A policy of close monitoring of blood pressure and weight gain, aiming adequate weight gain, may be added to current recommended measures. The high prevalence of PE in women with prepregnancy diabetes, especially those with initial pregnancy systolic blood pressure >124 mmHg, supports a policy of early institution of low dose aspirin. Further multicentric studies will help define the role of these risk factors as contributors to PE in pregestational diabetes.

KEYWORDS:

• Pregnancy in diabetics
• hypertension
• preeclampsia
• risk factors
• weight gain
• blood pressure
• pregnancy outcome

Authors’ contributions

Maria Lúcia da Rocha Oppermann: I declare that I participated in the conception and design, data statistical analysis and interpretation, article writing and revisions and take overall responsibility. I have seen and approved the final version. I have no conflicts of interest.

Janine Alessi: I declare that I participated in the data collection, article writing, and revision and that I have seen and approved the final version. I have no conflicts of interest.

Vânia Naomi Hirakata: I declare that I participated in the data statistical analysis and interpretation, article writing and revision and that I have seen and approved the final version. I have no conflicts of interest.

Daniela Mascarenhas Wiegand: I declare that I participated in the data collection, article writing, and revision and that I have seen and approved the final version. I have no conflicts of interest.

Angela Jacob Reichelt: I declare that I participated in the conception and design, data statistical analysis and interpretation, article writing and revisions and take overall responsibility. I have seen and approved the final version. I have no conflicts of interest.

Disclosure statement

No potential conflict of interest was reported by the authors.

Novelty statements

• Systolic blood pressure >124 mmHg in early pregnancy, adjusted for previous chronic hypertension, was a predictive risk factor for preeclampsia in women with pregestational diabetes.

• Excessive gestational weight gain and total gestational weight gain were both risk factors for preeclampsia in women with pregestational diabetes.

Additional information

Funding

This work was supported by FIPE-HCPA (Support Fund for Research and Events of Hospital de Clínicas de Porto Alegre) (project number 16-0331), which had no involvement in study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.