Complication of Insulin-Dependent Diabetic Pregnancies by Preeclampsia And/Or Chronic Hypertension: Analysis of Outcome

ABSTRACT

The significance of hypertensive complications of insulin-dependent diabetic pregnancies (IDDP) has not been well examined since the early reports of Pedersen, which demonstrated an increased risk of neonatal death in women with pregnancy induced hypertension (PIH). To assess the effect of both PIH and chronic hypertension (CH) on outcome of IDDP managed using contemporary obstetrical and diabetic management, we reviewed the records of all 199 IDDP delivered at our institution over a 7-year period. Patients were classified as having PIH (Group 1, n = 37), CH (Group 2, n = 18) or both (Group 3, n = 4) on the basis of standard clinical criteria. All other IDDP were placed in the control group (Group 4, n = 140). Comparing all groups, significant differences were found for maternal age (P < .0001) and distribution among White's Classes (P < .0001). There was no significant difference in estimated gestational age (EGA) at delivery, birthweight, Apgar scores, hypoglycemia, hyperbilirubinemia, or congenital anomalies. Intrauterinefetal death (IUFD) was no more common in Groups 1, 2 or 3 than in Group 4; however, IDDP with CH were significantly more likely to have had previous stillbirths than IDDP with PIH (P = .011) or control IDDP (P = .017). Contrary to common clinical belief, the “stress” of CH and PIH did not offer protection to the newborn in the development of RDS or HMD. In fact, Group 3 infants had a higher rate of HMD than control infants (P = .024). In summary, comparing IDDP with or without hypertensive complications, we conclude that IDDP with CH are more likely to have previous stillbirths; however, using contemporary obstetrical and diabetic management, neither CH nor PIH alters the risks of the infant experiencing the complications that commonly occur in diabetic pregnancies.