Hypertensive disorders in pregnant women affected by type 1 diabetes

Objectives: The aim of the study was to evaluate the incidence of hypertensive disorders in pregnant women affected by type 1 diabetes and the pregnancy outcome in women with or without hypertension. Materials and Methods: one hundred seventy-two pregnancies in 150 women affected by type 1 diabetes were assessed. Twelve pregnancies were excluded (8 pregnancies were excluded because of spontaneous abortions, 1 for voluntary abortion and 3 for twins), so 160 pregnancies were assessed. Middle age was 31.9±5.2. All patients were treated with insulin therapy, 20% with insulin pump and 80% with multi-injective insulin therapy. Results: Twenty-five pregnancies (15.6%) were complicated by hypertensive disorders: 28% by chronic hypertension, 32% by gestational hypertension, 28% by preeclampsia, and 12% preeclampsia superimposed on chronic hypertension. In the patients affected by chronic hypertension the mean week at delivery was 36±3.2, the mean birth weight was 2640.0±875.2 g and the mean birth percentile was 51°±30.46; in the patients affected by gestational hypertension the mean week at delivery was 37.5±1.69, the mean birth weight was 2936.3±566.7 g and the mean birth percentile was 51,2±31.2°; in the pregnancies complicated by preeclampsia, instead, the mean week at delivery was 36,1±2,54, the mean birth weight was 3092,9±1087,42g with a mean birth percentile of 64°±37,2. In the end, in the group of women with preeclampsia superimposed on chronic hypertension the mean week at delivery found was 35.7±2.3, the mean birth weight was 2453.3±525.4g with a percentile of 34.1±8.5. Instead, in the patients affected by type 1 diabetes but without hypertensive disorders the mean week at delivery was 35.6±2.24, the mean birth weight was 3266.0±686.8 g and the mean birth percentile was 58.3 ±28.9. The rate of preterm delivery was 60% in the pregnancies complicated by hypertensive disorders vs 14.1% in the pregnancies without hypertensive complications (p<<0.05). Furthermore, comparing the population with and without hypertensive complications we found significant differences in mean birth weight (p= 0.004) and gestational age at delivery (p<<0.05). Conclusions: as expected, the incidence of hypertensive disorders in pregnancies complicated by type 1 diabetes is higher than in general population. In addition, in our group of study, a poor pregnancy outcome was observed in pregnancies complicated by hypertensive disorders. None statistically significant difference ws observed between the group treated with insulin pump and the group treated with multi- injective insulin therapy.