Associations of Type 1 diabetes mellitus, maternal vascular disease and complications of pregnancy
- 24 August 2007
- journal article
- Published by Wiley in Diabetic Medicine
- Vol. 24 (11), 1229-1234
- https://doi.org/10.1111/j.1464-5491.2007.02254.x
Abstract
Maternal diabetes increases the risk of pre-eclampsia and abnormalities of fetal growth. We studied the additional impact of maternal vascular disease on these risks. The first viable (> 23 weeks) pregnancies of 138 women with Type 1 diabetes mellitus (Type 1 DM), delivered between 1994 and 2003 at the Queen's Medical Centre, Nottingham, UK were studied. Women were divided into groups with and without vascular disease (retinopathy and/or nephropathy and/or pre-existing hypertension). Primary outcomes were pre-eclampsia and fetal customized birthweight percentile (cbp) (adjusted for maternal weight, height, parity, ethnicity, gestational age and gender). Secondary outcomes were perinatal outcome (miscarriage, intrauterine or neonatal death), preterm birth, birth asphyxia, neonatal hypoglycaemia and delivery mode. Women with vascular disease were more likely to develop pre-eclampsia (OR 3.5; CI 1.28-9.53) and deliver infants with lower cbp (median 89.0, range 0-100 vs. 98.0, range 0-100; P < or = 0.005). Infants were less likely to be macrosomic (OR 0.46; CI 0.224-0.928) but more likely to have intrauterine growth restriction (IUGR; OR 6.0; CI 1.54-23.33). Women with vascular disease had higher Caesarean section rates (90 vs. 56%, P < or = 0.001). Women with Type 1 DM and vascular disease are at greater risk of pre-eclampsia and pathological fetal growth. This should influence counselling and merit increased pregnancy surveillance.Keywords
This publication has 17 references indexed in Scilit:
- Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitusAmerican Journal of Obstetrics and Gynecology, 2000
- Classification of hypertension in pregnancyBest Practice & Research Clinical Obstetrics & Gynaecology, 1999
- An adjustable fetal weight standardUltrasound in Obstetrics & Gynecology, 1995
- Diabetic fetal macrosomia: Significance of disproportionate growthThe Journal of Pediatrics, 1993
- Customised antenatal growth chartsThe Lancet, 1992
- Preeclampsia in diabetic pregnanciesAmerican Journal of Obstetrics and Gynecology, 1990
- A Longitudinal Study Comparing Growth in Diabetic Pregnancies with Growth in Normal GestationsObstetrical & Gynecological Survey, 1990
- Retinopathy in the Pregnant DiabeticClinical Obstetrics and Gynecology, 1985
- Diabetic Nephropathy in PregnancyClinical Obstetrics and Gynecology, 1985
- Pregnancy in Diabetes Complicated by Vascular DiseaseDiabetes, 1977