Rate of Gestational Diabetes Mellitus and Pregnancy Outcomes in Patients with Chronic Hypertension

Abstract

Objective This study aims to determine the rate of gestational diabetes mellitus (GDM) in pregnancies complicated by chronic hypertension and to compare the adverse outcomes in chronic hypertensive pregnancies with and without GDM.

Study Design A secondary analysis from a multicenter trial of low-dose aspirin for preeclampsia prevention in women with chronic hypertension. The rate of GDM was evaluated among singleton pregnancies complicated with chronic hypertension and grouped according to their GDM status. Pregnancy outcomes and rates of preterm delivery < 35 weeks and < 32 weeks, preeclampsia, indicated preterm birth, small for gestational age, abruptio placentae, and perinatal death were compared between those with and without GDM. A subgroup analysis comparing women who developed superimposed preeclampsia with and without GDM was studied. Multivariate logistic-regression analysis was used to adjust for potentially confounding factors.

Results A total of 763 women met the inclusion criteria: 129 (17%) developed GDM. Parity, race, maternal baseline blood pressure, antihypertensive drug use, and assignment to low-dose aspirin were not significantly different between the groups with and without GDM. Using univariate analysis, maternal age (33 vs. 24%, p = 0.03) and body mass index (88 vs. 57%, p < 0.001) were higher in those who had GDM, whereas the rate of preterm delivery < 32 weeks (12 vs. 5%, p = 0.02) was higher among those without GDM. Using logistic-regression analysis, the rate of composite adverse outcomes (adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.41–1.47) that included indicated preterm birth, small for gestational age, abruptio placentae, and perinatal death showed no significant differences.

Superimposed preeclampsia developed in 34 (26%) women with GDM and in 182 (29%) without GDM. When superimposed preeclampsia was present, it developed at an earlier gestational age among the group without GDM (35 ± 5 vs. 37 ± 3 weeks, p = 0.003), and had higher rates of small for gestational age infants (18 vs. 3%, p = 0.03). After adjustment for confounders, only length of stay in neonatal intensive care unit was longer for those without GDM who developed superimposed preeclampsia (aOR, 0.42; 95% CI, 0.2–0.93).

Conclusion Women with chronic hypertension are at a high risk for developing GDM. Outcomes in patients with chronic hypertension and GDM are not significantly different from those with chronic hypertension only.

Keywords

chronic hypertension - gestational diabetes mellitus - superimposed preeclampsia

Poster presented at the 35th Annual Meeting of the Society of Maternal Fetal Medicine; February 2–7, 2015; San Diego, CA.

• References

• 1 Yanit KE, Snowden JM, Cheng YW, Caughey AB. The impact of chronic hypertension and pregestational diabetes on pregnancy outcomes. Am J Obstet Gynecol 2012; 207 (4) 333.e1-333.e6
• 2 Stella CL, O'Brien JM, Forrester KJ , et al. The coexistence of gestational hypertension and diabetes: influence on pregnancy outcome. Am J Perinatol 2008; 25 (6) 325-329
• 3 Texas Health and Human Services Commision . Gestational Diabetes in Medicaid. Rider 75, Senate Bill 1, 83rd Legislature. Available at: http://www.hhsc.state.tx.us/reports/2014/SB1-Gestational-Diabetes.pdf . Accessed Aug 31, 2014
• 4 Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am 2007; 34 (2) 173-199 , vii
• 5 Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol 2012; 206 (2) 134.e1-134.e8
• 6 O'Sullivan EP, Avalos G, O'Reilly M, Dennedy MC, Gaffney G, Dunne FP ; Atlantic DIP collaborators. Atlantic DIP: the prevalence and consequences of gestational diabetes in Ireland. Ir Med J 2012; 105 (5, Suppl): 13-15
• 7 Metzger BE, Lowe LP, Dyer AR , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
• 8 Ostlund I, Haglund B, Hanson U. Gestational diabetes and preeclampsia. Eur J Obstet Gynecol Reprod Biol 2004; 113 (1) 12-16
• 9 Shand AW, Bell JC, McElduff A, Morris J, Roberts CL. Outcomes of pregnancies in women with pre-gestational diabetes mellitus and gestational diabetes mellitus; a population-based study in New South Wales, Australia, 1998-2002. Diabet Med 2008; 25 (6) 708-715
• 10 Caritis S, Sibai B, Hauth J , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Low-dose aspirin to prevent preeclampsia in women at high risk. N Engl J Med 1998; 338 (11) 701-705
• 11 Brenner WE, Edelman DA, Hendricks CH. A standard of fetal growth for the United States of America. Am J Obstet Gynecol 1976; 126 (5) 555-564
• 12 Roberts JM, August PA, Bakris G , et al; American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (5) 1122-1131
• 13 Moussa HN, Arian SE, Sibai BM. Management of hypertensive disorders in pregnancy. Womens Health (Lond Engl) 2014; 10 (4) 385-404
• 14 National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28 (12) 1039-1057
• 15 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144 (7) 768-773
• 16 DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis 2014; 11: E104
• 17 Chen Y, Quick WW, Yang W , et al. Cost of gestational diabetes mellitus in the United States in 2007. Popul Health Manag 2009; 12 (3) 165-174
• 18 Skupień J, Cyganek K, Małecki MT. Diabetic pregnancy: an overview of current guidelines and clinical practice. Curr Opin Obstet Gynecol 2014; 26 (6) 431-437
• 19 Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2 Pt 1) 406-416
• 20 Suhonen L, Teramo K. Hypertension and pre-eclampsia in women with gestational glucose intolerance. Acta Obstet Gynecol Scand 1993; 72 (4) 269-272
• 21 Joffe GM, Esterlitz JR, Levine RJ , et al; Calcium for Preeclampsia Prevention (CPEP) Study Group. The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women. Am J Obstet Gynecol 1998; 179 (4) 1032-1037
• 22 Sevket O, Ates S, Uysal O, Molla T, Dansuk R, Kelekci S. To evaluate the prevalence and clinical outcomes using a one-step method versus a two-step method to screen gestational diabetes mellitus. J Matern Fetal Neonatal Med 2014; 27 (1) 36-41