Urinary albumin excretion and 24-hour blood pressure as predictors of pre-eclampsia in Type I diabetes

Ekbom, Pia; Damm, Peter; Nørgaard, Kirsten; Clausen, Peter; Feldt‐Rasmussen, Ulla; Feldt‐Rasmussen, Bo; Nielsen, Lise Hald; Mølsted‐Pedersen, Lars; Mathiesen, E. R.

doi:10.1007/s001250051471

Cited by 51 publications

(50 citation statements)

References 7 publications

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“…This population has been described in detail previously (12)(13)(14). Likewise, a study of 72 pregnancies in women with type 2 diabetes during 1980 -1992 from the same department was used for comparison (7).…”

Section: Methodsmentioning

confidence: 99%

Poor Pregnancy Outcome in Women With Type 2 Diabetes

et al. 2005

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OBJECTIVE -To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996 -2001.RESEARCH DESIGN AND METHODS -Medical records of 61 consecutive singleton pregnancies in women with type 2 diabetes from 1996 to 2001 were studied. Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996 -2000, the background population, and pregnant women with type 2 diabetes during 1980 -1992 from the same department.RESULTS -The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.6%) was increased four-and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2 diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA 1c at admission and type 2 diabetes were independently associated with a serious adverse fetal outcome (perinatal mortality and/or major congenital malformations). The perinatal mortality and the rate of major congenital malformations in type 2 diabetic pregnancies have increased during the last decade.CONCLUSIONS -The perinatal outcome of pregnancies in women with type 2 diabetes during 1996 -2001 is poor. It is worse than the outcome of pregnancies in women with type 1 diabetes and the background population in the same period, as well as in women with type 2 diabetes studied during 1982-1990. Diabetes Care 28:323-328, 2005T he prevalence of type 2 diabetes is increasing rapidly in all age-groups. In line with this, it is a general clinical observation that the number of pregnant women with pregestational type 2 diabetes has become more frequent in the recent years; however, little knowledge exists concerning the prevalence and outcome of these pregnancies (1,2).A study from Birmingham, U.K., showed a similar perinatal mortality but a higher frequency of congenital malformations, preterm delivery, large-forgestational-age infants, and fetal loss before 24 weeks' gestation in 57 pregnancies in women with type 2 diabetes compared with pregnancies in women with type 1 diabetes (3,4). In 182 pregnancies in women with type 2 diabetes compared with the general population, there was a 2.5-fold greater risk of perinatal mortality and an 11-fold greater risk of a congenital malformation (5). A study from New Zealand reported a threefold increased perinatal mortality rate in pregnancies related to type 2 diabetes compared with pregnancies related to type 1 diabetes. In addition, the study indicated that the outcome was poorer if type 2 diabetes was diagnosed during pregnancy compared with before pregnancy (6). The prevalence of type 2 diabetes in pregnancy was the highest in non-Caucasian women, who had a nonsignificantly higher HbA 1c dur...

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Section: Methodsmentioning

confidence: 99%

Poor Pregnancy Outcome in Women With Type 2 Diabetes

et al. 2005

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“…The presence of hypertension is of importance for the prediction of preeclampsia (21,22). However, the clinical value of BP as an early predictor of preeclampsia has been demonstrated to be of minor importance because of a great overlap in BP in women in whom preeclampsia developed and in women who remained normotensive (23). The White classification was not an independent predictor of preterm delivery or preeclampsia.…”

Section: Discussionmentioning

confidence: 97%

Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria

Ekbom¹,

Damm²,

et al. 2001

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OBJECTIVE -To determine the influence of microalbuminuria on pregnancy outcome in women with type 1 diabetes.RESEARCH DESIGN AND METHODS -This prospective cohort study took place at the Obstetric Clinic at National University Hospital, Copenhagen, from January 1996 to February 2000. All Caucasian women with type 1 diabetes, unselected from the eastern part of Denmark, with a living fetus before 17 weeks of gestation on admission were asked to participate. For women with more than one delivery in the study period, only the first pregnancy was included. Of the remaining 246 women, 240 (98%) entered the study. They were categorized according to their urinary albumin excretion (normal urinary albumin excretion, Ͻ30 mg/24 h; microalbuminuria, 30 -300 mg/24 h; or diabetic nephropathy, Ͼ300 mg/24 h) before pregnancy or in the first trimester.RESULTS -A total of 203 women (85%) had normal urinary albumin excretion, 26 (11%) had microalbuminuria, and 11 (5%) had diabetic nephropathy. Mean HbA 1c at 2-6 weeks was 7.5% (SD 1.1), 8.1 (0.9), and 8.8 (1.3) (P Ͻ 0.001), respectively. Of all deliveries in women with normal urinary albumin excretion, microalbuminuria, and diabetic nephropathy, 35, 62, and 91% (P Ͻ 0.001), respectively, were preterm, and 2, 4, and 45% (P Ͻ 0.001), respectively, were small-for-gestational-age infants. Preeclampsia developed in 6, 42, and 64% of the women (P Ͻ 0.001), respectively. Category of urinary albumin excretion (P Ͻ 0.01) and HbA 1c at 2-6 weeks (P Ͻ 0.05) were independently associated with preterm delivery.CONCLUSIONS -The prevalence of preterm delivery is considerably increased in women with microalbuminuria, mainly caused by preeclampsia. Classification according to urinary albumin excretion and metabolic control around the time of conception are superior to the White classification in predicting preterm delivery in women with type 1 diabetes.

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“…Optimal glycemic control is crucial in order to reduce the risk of congenital malformations, stillbirth, macrosomia, preeclampsia, and preterm delivery (2)(3)(4)(5). However, striving for near normoglycemia increases the risk of severe hypoglycemia (6), which is the major limiting factor for achieving optimal blood glucose control in pregnant women with type 1 diabetes (7).…”

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confidence: 99%

Hypoglycemia in Pregnant Women With Type 1 Diabetes

et al. 2008

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OBJECTIVE -In pregnancy with type 1 diabetes, we evaluated occurrence of mild and severe hypoglycemia and analyzed the influence of strict metabolic control, nausea, vomiting, and other potential predictors of occurrence of severe hypoglycemia. RESEARCH DESIGN AND METHODS-A prospective observational study of 108 consecutive pregnant women with type 1 diabetes was conducted. At 8,14,21, 27, and 33 weeks of gestation, patients performed self-monitored plasma glucose (SMPG) (eight/day) for 3 days and completed a questionnaire on nausea, vomiting, hypoglycemia awareness, and history of mild (managed by the patient) and severe (requiring assistance from others) hypoglycemia.RESULTS -Forty-nine (45%) women experienced 178 severe hypoglycemic events, corresponding to 5.3, 2.4, and 0.5 events/patient-year in the first, second, and third trimesters, respectively. The incidence of mild hypoglycemia was 5.5 events/patient-week in early pregnancy and decreased throughout pregnancy (P Ͻ 0.0001), regardless of presence of severe hypoglycemia. Prevalence of nausea and vomiting, mild hypoglycemia, and fraction of SMPG readings Յ3.9 mmol/l did not differ between women with and without severe hypoglycemia. A1C, median SMPG, and fluctuations in SMPG decreased during pregnancy, with no differences between women with and without severe hypoglycemia. Logistic regression analysis identified history of severe hypoglycemia the year preceding pregnancy (odds ratio 3.3 [95% CI 1.2-9.2]) and impaired awareness or unawareness (3.2 [1.2-8.2]) as independent predictors for severe hypoglycemia.CONCLUSIONS -In pregnancy with type 1 diabetes, the incidence of mild and severe hypoglycemia was highest in early pregnancy, although metabolic control was tighter in the last part of pregnancy. Predictors for severe hypoglycemia were history of severe hypoglycemia and impaired awareness. Diabetes Care 31:9-14, 2008P regnancy outcome among women with type 1 diabetes is still significantly poorer than in the background population (1). Optimal glycemic control is crucial in order to reduce the risk of congenital malformations, stillbirth, macrosomia, preeclampsia, and preterm delivery (2-5). However, striving for near normoglycemia increases the risk of severe hypoglycemia (6), which is the major limiting factor for achieving optimal blood glucose control in pregnant women with type 1 diabetes (7).Severe hypoglycemia is three times as frequent in early pregnancy compared with the period before pregnancy (8), and the incidence is highest in gestational week 8 -16 and lower in the second part of pregnancy (7). Traffic accidents (9) and death (10) due to severe hypoglycemia in pregnancy are rare but significant problems. Pregnancy-induced nausea and vomiting have been proposed to be contributing factors for severe hypoglycemia in early pregnancy (7,8). Hypoglycemia unawareness is a major predictor for severe hypoglycemia in nonpregnant patients with type 1 diabetes (11), but its significance during pregnancy in type 1 diabetes is not known. It is not known w...

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Urinary albumin excretion and 24-hour blood pressure as predictors of pre-eclampsia in Type I diabetes

Cited by 51 publications

References 7 publications

Poor Pregnancy Outcome in Women With Type 2 Diabetes

Poor Pregnancy Outcome in Women With Type 2 Diabetes

Pregnancy Outcome in Type 1 Diabetic Women With Microalbuminuria

Hypoglycemia in Pregnant Women With Type 1 Diabetes

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