Risk Factors for Pregnancy Hypertensive Disorders in a Cohort of Women with Pregestational Diabetes

Background: Pregestational diabetes (PGD) is associated with increased incidence of pregnancy hypertensive disorders (PHD).

Aim: to describe incidence and risk factors for PHD in a retrospective cohort of PGD women.

Methods: Women were evaluated at a specialized prenatal care facility. PHD comprised preeclampsia and gestational hypertension. Gestational weight gain (GWG) was categorized as excessive/non-excessive (2009 IOM); A1C test was measured before the 28^th gestational week; most women did not receive prepregnancy counseling.

Results: Of 220 women, 85 were type 1 and 135, type 2 diabetes. Main characteristics (type 1 x type 2) were: age 27.3 (5.7) x 33.5 (5.5) years, p<0.001; self-declared white skin: 88.2% x 76.3%, p=0.044; primigravid: 48.2% x 15.6%, p<0.001; previous PHD: 8.2% x 20.7%, p=0.023; CH: 14.1% x 29.6%, p=0.013; initial A1c test ≥7.0%: 84.3% x 64.3%, p=0.002; excessive GWG: 27.0% x 35.9%, p=0.264. PHD was diagnosed in 64 of 213 women (30%; 95% CI: 24.2-36.5%) and 52 (23.6%; 95% CI 18.4-29.7%) had CH. The Table lists adjusted RR for risk factors.

Conclusion: This PGD cohort showed an increased incidence of PHD, which supports early pregnancy preventive measures, as aspirin. Excessive GWG, a modifiable risk factor, may be prevented through focused prepregnancy and antenatal surveillance.

Table. Risk Factors for Pregnancy Hypertensive Disorders in 213 Women with Pregestational Diabetes.