Background: In pregestational diabetes (PGD) pregnancies, blood pressure (BP) close to normal is warranted to prevent pregnancy hypertensive disorders (PHD); targets are not well defined. Diastolic BP (DBP) was recently described as a modifiable factor.
Aim: to evaluate distinct levels of DBP as risk factors to PHD in a retrospective cohort of PGD women.
Methods: Women were cared for at a specialized prenatal care facility. DBP measured at the first antenatal appointment was categorized. Poisson regression with robust estimates was used.
Results: Baseline characteristics of women are in Table 1, and multivariable analysis, in Table 2.
Conclusion: In this PGD cohort, a DBP >80 mmHg at booking was associated to increased risk of PHD, suggesting that levels above this value should be prevented.
Table 1. Characteristics of Pregestational Women
| Type 1 diabetes (n=84) | Type 2 diabetes (n=129) | |||||
| PHD 32 (38.1) | No PHD 52 (61.9) | p | PHD 32 (24.8) | No PHD 97 (75.2) | p | |
| Age (years) | 26.8 (5.5) | 27.7 (5.9) | 0.515 | 34.1 (4.3) | 33.1 (5.8) | 0.385 |
| Self-declared white | 93.8 | 84.6 | 0.364 | 96.9 | 70.1 | 0.004 |
| Years since diagnosis | 15.4 (7.3) | 11.9 (8.7) | 0.058 | 6.8 (6.2) | 3.5 (4.2) | 0.008 |
| Previous PHD | 4 (12.5) | 3 (5.8) | 0.498 | 6 (18.8) | 22 (22.7) | 0.826 |
| Chronic hypertension | 8 (25.0) | 4 (7.7) | 0.050 | 16 (50.0) | 24 (24.7) | 0.014 |
| Systolic BP (mmHg) | 120 (14) | 116 (14) | 0.214 | 128 (16) | 119 (14) | 0.003 |
| Diastolic BP (mmHg) | 77 (13) | 72 (10) | 0.042 | 82 (13) | 76 (11) | 0.025 |
| DBP > 70 mmHg | 56.2 | 48.1 | 0.615 | 62.1 | 61.5 | >0.999 |
| DBP > 75 mmHg | 56.2 | 46.2 | 0.500 | 62.1 | 60.4 | >0.999 |
| DBP > 80 mmHg | 21.9 | 5.8 | 0.062 | 37.9 | 23.1 | 0.182 |
| Type 1 diabetes (n=84) | Type 2 diabetes (n=129) | |||||
| PHD 32 (38.1) | No PHD 52 (61.9) | p | PHD 32 (24.8) | No PHD 97 (75.2) | p | |
| Age (years) | 26.8 (5.5) | 27.7 (5.9) | 0.515 | 34.1 (4.3) | 33.1 (5.8) | 0.385 |
| Self-declared white | 93.8 | 84.6 | 0.364 | 96.9 | 70.1 | 0.004 |
| Years since diagnosis | 15.4 (7.3) | 11.9 (8.7) | 0.058 | 6.8 (6.2) | 3.5 (4.2) | 0.008 |
| Previous PHD | 4 (12.5) | 3 (5.8) | 0.498 | 6 (18.8) | 22 (22.7) | 0.826 |
| Chronic hypertension | 8 (25.0) | 4 (7.7) | 0.050 | 16 (50.0) | 24 (24.7) | 0.014 |
| Systolic BP (mmHg) | 120 (14) | 116 (14) | 0.214 | 128 (16) | 119 (14) | 0.003 |
| Diastolic BP (mmHg) | 77 (13) | 72 (10) | 0.042 | 82 (13) | 76 (11) | 0.025 |
| DBP > 70 mmHg | 56.2 | 48.1 | 0.615 | 62.1 | 61.5 | >0.999 |
| DBP > 75 mmHg | 56.2 | 46.2 | 0.500 | 62.1 | 60.4 | >0.999 |
| DBP > 80 mmHg | 21.9 | 5.8 | 0.062 | 37.9 | 23.1 | 0.182 |
Mean (SD) or %
Table 2. Risk of Pregnancy Hypertensive Disorders (n=178)
| Risk factor | Relative risk | 95% CI | p |
| Type 1 diabetes | 1.91 | 1.20-3.02 | 0.006 |
| Self-declared white skin | 3.71 | 1.22-11.27 | 0.021 |
| Primigravid | 1.13 | 0.76-1.68 | 0.558 |
| Diastolic blood pressure > 80 mmHg | 1.64 | 1.05-2.56 | 0.031 |
| Initial A1c test ≥7.0% | 0.678 | 0.44-1.05 | 0.083 |
| Excessive GWG | 1.55 | 1.04-2.30 | 0.030 |
| Risk factor | Relative risk | 95% CI | p |
| Type 1 diabetes | 1.91 | 1.20-3.02 | 0.006 |
| Self-declared white skin | 3.71 | 1.22-11.27 | 0.021 |
| Primigravid | 1.13 | 0.76-1.68 | 0.558 |
| Diastolic blood pressure > 80 mmHg | 1.64 | 1.05-2.56 | 0.031 |
| Initial A1c test ≥7.0% | 0.678 | 0.44-1.05 | 0.083 |
| Excessive GWG | 1.55 | 1.04-2.30 | 0.030 |
M.R. Oppermann: None. V.N. Hirakata: None. J. Alessi: None. D. Wiegand: None. A.J. Reichelt: None.
