Objective: To evaluate delivery outcomes in women with concurrent type 1 diabetes and chronic hypertension (cHTN) treated with anti-hypertensive pharmacotherapy to target blood pressure (BP) 110-129/65-79 mmHg throughout pregnancy per ADA 2008-2016 guidelines.
Research Design and Methods: We abstracted clinical data from the medical records of 752 pregnancies derived from 550 women seeking prenatal care at the Joslin Diabetes Center and Beth Israel Deaconess Medical Center’s Diabetes in Pregnancy Program from 2004-2017. We calculated means and percentages, used t test or ?2 test, and linear regression to compare trimester specific BP values, birth weight and prevalence of small for gestational age (SGA) in pregnancies of women with type 1 diabetes and cHTN to those with type 1 diabetes and no cHTN.
Results: Type 1 diabetes and cHTN occurred in 51 (6.7%) of pregnancies and the mean BP values were 128/76 in the first trimester; 122/72 in the second trimester; 124/76 in the third trimester; 137/82 prior to delivery. BP values were significantly higher in women with type 1 diabetes and cHTN for each trimester compared to women with type 1 diabetes and no cHTN (p<0.001). Women with type 1 diabetes and cHTN were older (33.4 vs. 31.5 years p=0.04), had higher BMI (28.3 vs. 26.6 kg/m2 p=0.03), were more likely to have diabetic nephropathy (10.4% vs. 2%, p<0.001) and use insulin pumps (75.5% vs. 60%, p=0.04). There were no significant differences in gestational age at delivery and birth weight. SGA in both groups was rare, with 0 (0%) in the type 1 diabetes with cHTN group and 5 (0.9%) in the group without cHTN (p=0.54).
Conclusion: SGA is rare in pregnancies complicated by type 1 diabetes and cHTN and did not differ from those without cHTN, even when BP targets of 110-129/65-79 mmHg are used. This may provide reassurance to reestablish these lower BP targets rather than the recently adopted higher targets of 120-160/80-105 mmHg followed by ACOG since 2013 and ADA since 2017.
S. Helman: None. T. James-Todd: None. F.M. Brown: None.