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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Article info
Publication history
Published online: February 20, 2018
Accepted:
February 6,
2018
Received in revised form:
January 9,
2018
Received:
August 3,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
