Hypertensive disorders in pregnant women affected by type I diabetes

Introduction Type I diabetes in pregnancy is associated with an increased incidence of hypertensive disorders. Objectives The aim of the present study was to evaluate the incidence of hypertensive disorders in pregnant women affected by type I diabetes and pregnancy outcome in women with and without hypertension. Methods One hundred seventy two pregnancies in 150 women affected by type I diabetes were assessed. Twelve pregnancies were excluded (8 because of spontaneous abortions, 1 for voluntary abortion and 3 twin pregnancies), and 160 pregnancies were considered for the study. Results Twenty-five pregnancies (15.6%) were complicated by hypertensive disorders: 4.4% by chronic hypertension (CH), 5% by gestational hypertension (GH), 4.4% by preeclampsia (PE) and 1.8% by preeclampsia superimposed on chronic hypertension (PE+CH); 32% of the women presented a vascular disease (renal or retinal disease). The diabetic women with hypertensive complications were compared with diabetic women without hypertension. The main results are shown in Table 1. Significant differences in mean birth weight and mean gestational age were found. The group affected by preeclampsia showed 14.7% of small for gestational age (SGA) neonates (birth weight percentile less than 10th pc), and 57.1% of large for gestational age (LGA) neonates (birth weight percentile greater than 90th pc), two of them were over 4000 g. Only one case of very preterm delivery (<32 weeks) was observed in the sample. Week at delivery (mean±SD)Peso (g) (mean±SD)pc° (mean±SD)Diabetic controls38.7±2.23272±662.357.9±28.5CH36.0±3.22640.0±875.251.0±30.5GH37.3±1.72936.3±566.751.2±31.2PE36.1±2.53092.9±1087.464.0±37.2PE on CH35.7±2.32453.0±525.434.0±8.5p-Valuep<0.05 between diabetic controls vs CH,PE and PEonCHp<0.05 between diabetic controls vs CH an PEonCHns Conclusion As expected, the incidence of hypertensive disorders in population affected by type 1 diabetes is higher than in general population and a poor pregnancy outcome was observed in this group of women. However, the neonatal outcome of women affected by preeclampsia is not different from that observed in women without hypertensive complications (diabetic controls) in terms of mean birth weight despite a significantly lower mean week gestation at delivery.