25 Risk factors for preeclampsia in pregnant women ith type 1 diabetes mellitus

Abstract

Background Hypertensive disorders are the major cause of maternal mortality at Brazil. Diabetes mellitus (DM) since before pregnancy is an independent risk factor for preeclampsia (PE), increasing up to four times its incidence. Predicting the PE development can direct special medical care and preventive measures to reduce the maternal and fetal risks. Objective To evaluate risk factors for development of Preeclampsia in pregnant women with type 1 Diabetes Mellitus. Methods A prospective cohort study that evaluated pregnant women diagnosed with Type 1 Diabetes Mellitus whose prenatal follow-up was performed at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP) between the years 2013 and 2016. For analysis of the results at the end of the study, the patients were divided into two groups: without PE (I) and with PE (II). Statistical tests chi-square and analysis of variance (ANOVA) were performed, as well as analysis of the relative risk, with the help of IBM SPSS 16 software, considering the significance level of p Results 65 pregnant women diagnosed with type 1 DM were attended during the period. The incidence of preeclampsia was 30.8% (n = 20). The mean age was 26.9 years ( ± 5.49) in group I and 27.5 years ( ± 7.51) in group II, p = 0.51; also there was no statistical difference when comparing the frequencies at extremes of age ( 18 or > 40 years). They were similar to the mean height (1.60 ± 0.05 vs 1.58 ± 0.07 m, p = 0.19), weight (60.68 ± 9.95 vs. 59.48 ± 6.8 kg , p = 0.65) and Body Mass Index (23.04 ± 3.63 versus 23.20 ± 2.43 kg/m, p = 0.85); obesity frequency was also no statistical difference. Regarding the DM evolution time, the average was 13.9 years ( ± 7.28) in group I and 15.5 years ( ± 7.59) in those who developed PE, with p = 0.29. There was no difference in relation to peri-conceptional glycemic control as measured by glycosylated hemoglobin in the first trimester, with an average of 8.46% ( ± 1.58) in group I and 8.59% ( ± 1.25) in group II. Nineteen (95%) patients with PE were nulliparous, against 26 (57.8%) without PE (RR = 8.34, CI = 1.21 to 58.8; p = 0.00312). Similarly, 80% (n = 16) of patients with PE were primigravidae against only 44.4% (n = 20) of pregnants without this outcome (RR = 3.22, CI = 1.2 to 8.58; p = 0.0193). Chronic Arterial hypertension was present in 33.3% (n = 7) of patients with preeclampsia and 11.1% (n = 5) in the other group (RR = 2.37, CI = 1.21 to 4, 65, p = 0.0115). The frequency of target organ lesions was similar in both groups, assessed by the presence of retinopathy (I: 24.4% vs. II: 38.1%, p = 0.19) and nephropathy (I: 20% versus II: 33.3%, p = 0.17). Conclusions Risk factors associated with increased incidence of preeclampsia in pregnant women with type 1 DM in this cohort were Nulliparity and presence of chronic Hypertension. In this survey, however, other risk factors described in the literature as maternal age and obesity had no influence on the risk of developing gestacional hypertensive syndrome. Other data such as peri-conceptional glycemic control, time to disease progression and target organ lesions also had no statistical difference.