Early pregnancy clinical risk factors for preeclampsia in women with type 1 and type 2 diabete

Aim: To assess the prevalence of pregnancy-induced hypertensive disorders and to identify early clinical, modifiable predictors of preeclampsia in women with type 1 and type 2 diabetes.
Methods: A population-based cohort study of 494 women with pre-existing diabetes (307 type 1 and 187 type 2 diabetes), included at their first antenatal visit at 11±6 gestational weeks (mean±SD) from 2012 to 2016. Predictors of preeclampsia present at first antenatal visit were sought identified.
Results: At the first antenatal visit HbA1c was 6.9±2.3 % (51±10 mmol/mol) vs. 6.8±2.6 % (49±14 mmol/mol) and blood pressure 120±12/76±8 mmHg vs. 122±14/79±10 mmHg, (p=0.16/p=0.001) in women with type 1 and type 2 diabetes, respectively. Preeclampsia developed in 40 women at 36±3 gestational weeks with delivery 8±9 days later. The prevalence of preeclampsia was 8% (9% vs. 7%) and gestational hypertension 8% (9% vs. 6%). Univariate analysis identified nulliparity, presence of retinopathy or diabetic nephropathy including microalbuminuria and increasing blood pressure as predictors of preeclampsia. At the first antenatal visit, presence of diabetic microangiopathy (nephropathy, microalbuminuria and/or retinopathy) and diastolic blood pressure, were independently, positively associated with the development of preeclampsia, while neither diabetes type or HbA1c were associated with preeclampsia in this group of women with pre-existing diabetes and comparable good glycemic control.
Conclusion: At the first antenatal visit, diastolic blood pressure was the only independent, potentially modifiable risk factor for preeclampsia, in women with pre-existing diabetes regardless of diabetes type.