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

  • Author Footnotes
    1 Permanent address: Hillerødgade 55, 2nd left, 2200 Copenhagen N, Denmark.
    Sidse Kjærhus Nørgaard
    Correspondence
    Corresponding author at: Center for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark. Fax: +45 35 45 22 10.
    Footnotes
    1 Permanent address: Hillerødgade 55, 2nd left, 2200 Copenhagen N, Denmark.
    Affiliations
    Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark

    Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
    Search for articles by this author
  • Marianne Jenlev Vestgaard
    Affiliations
    Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark

    Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author
  • Isabella Lindegaard Jørgensen
    Affiliations
    Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark

    Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
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  • Björg Ásbjörnsdóttir
    Affiliations
    Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark

    Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Lene Ringholm
    Affiliations
    Steno Diabetes Center Copenhagen, Gentofte, Denmark
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  • Harold David McIntyre
    Affiliations
    Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark

    Mater Clinical School and Mater Research, The University of Queensland, Brisbane, Australia
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  • Peter Damm
    Affiliations
    Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
    Search for articles by this author
  • Elisabeth Reinhardt Mathiesen
    Affiliations
    Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark

    Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author
  • Author Footnotes
    1 Permanent address: Hillerødgade 55, 2nd left, 2200 Copenhagen N, Denmark.
Published:February 20, 2018DOI:https://doi.org/10.1016/j.diabres.2018.02.014

      Highlights

      • One out of four women with diabetes had hypertensive disorders during pregnancy.
      • Diastolic blood pressure in early pregnancy is an important risk factor for preeclampsia.
      • Intensified monitoring and treatment of the blood pressure should be considered.

      Abstract

      Aims

      To identify early clinical, modifiable risk factors for preeclampsia present at first antenatal visit and assess the prevalence of pregnancy-related hypertensive disorders in women with pre-existing diabetes treated with tight glycemic and blood pressure (BP) control.

      Methods

      A population-based cohort study of 494 women with pre-existing diabetes (307 and 187 women with type 1 and type 2 diabetes, respectively), included at their first antenatal visit from 2012 to 2016. The prevalence of chronic hypertension (without diabetic nephropathy or microalbuminuria), gestational hypertension and preeclampsia was recorded. Diabetic microangiopathy included presence of nephropathy, microalbuminuria and/or retinopathy. Treatment target was BP <135/85 mmHg.

      Results

      HbA1c was 6.9 ± 2.4% (50 ± 12 mmol/mol) at first antenatal visit and 6.0 ± 0.6% (43 ± 6 mmol/mol) before delivery with no differences between women with type 1 and type 2 diabetes. At the first antenatal visit, the prevalence of microalbuminuria was 6% (6% vs. 6%), nephropathy 2% (1% vs. 2%) and chronic hypertension 6% (3% vs. 10%, p = 0.03). Gestational hypertension developed in 8% (9% vs. 6%) and preeclampsia developed in 8% (9% vs. 7%). Presence of diabetic microangiopathy (adjusted odds ratio (OR) 4.35 (confidence interval 2.12–8.93)) and diastolic BP (adjusted OR 1.72 per 10 mmHg (1.05–2.82)) at the first antenatal visit were independent risk factors for preeclampsia.

      Conclusions

      At the first antenatal visit, diastolic BP was the only independent, potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes in the context of tight glycemic and BP control. One out of four women had hypertensive disorders during pregnancy.

      Keywords

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