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Am J Perinatol 2021; 38(05): 428-435
DOI: 10.1055/s-0039-1698831
Review Article

Review of Prediabetes and Hypertensive Disorders of Pregnancy

Nicholas W. Carris 
1   Department of Pharmacotherapeutics and Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, Florida
2   Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
,
Chinedu K. Nwabuobi
3   Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
,
Weiwei He
4   Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
,
Krystal Bullers
5   Shimberg Health Sciences Library, University of South Florida, Tampa, Florida
,
Roneé E. Wilson
4   Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida
,
Judette M. Louis
3   Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
,
Ronald R. Magness
3   Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida
› Author Affiliations
Funding NIH HL117341 (R.R.M.) funding supported time for the completion of this article. The funding agency played no role in design, data collection, data analysis, or data interpretation or in the writing of the report or the decision to submit for publication.
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Abstract

Obesity and diabetes increase hypertensive disorders of pregnancy (HDP) risk, thus preventive interventions are heavily studied. How pregestational prediabetes and related interventions impact HDP risk is less characterized. Therefore, we searched and reviewed the literature to assess the impact on HDP risk of prediabetes and varied interventions. We identified 297 citations related to pregnancy, prediabetes, and early pregnancy interventions. We also reviewed the references and citations of included articles. We included five studies assessing HDP outcomes in women with first trimester hemoglobin A1c in the prediabetes range (5.7–6.4%). One prospective observational study demonstrated first trimester hemoglobin A1c (5.9–6.4%) is associated with increased HDP risk, while another prospective observational study and one retrospective observational study had similar trends without statistical significance. A small and underpowered randomized controlled trial demonstrated initiating gestational diabetes mellitus treatment (i.e., diet, monitoring, ± insulin) in response to first trimester hemoglobin A1c (5.7–6.4%) did not statistically reduce HDP compared with standard care. One retrospective observational study suggested metformin, when started early, may reduce HDP risk in patients with prediabetes. Pregestational prediabetes appears to increase HDP risk. Interventions (i.e., metformin, diet/glucose monitoring, and/or exercise) to reduce HDP risk require additional study with long-term follow-up.

Keywords

first trimester of pregnancy - hemoglobin A1c - hypertension - prediabetes - preeclampsia

Supplementary Material



Publication History

Received: 15 May 2019

Accepted: 07 September 2019

Article published online:
10 November 2019

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