Hypertensive Disorders in Normal/Over-weight and Obese Type 2 Diabetic Pregnant Women

Abstract

Background: Hypertension is one of the major complications of pregnancy. Its impact in type 2 diabetic pregnant women could be understimated because it is generally evaluated by retrospective studies and as one of the outcome measures.

Objective: Our aims were: 1) to evaluate the prevalence of hypertensive disease between type 2 diabetic and normal pregnancies; 2) to relate hypertensive disease to body weight in type 2 diabetic pregnancies; 3) to assess the impact of different types of hypertension on pregnancy outcome in type 2 diabetic women.

Study Design: Seventy-six type 2 diabetic (23 normal-weight, 26 overweight and 27 obese) and sixty normal (43, 15 and 2 respectively; x² 0.0001) pregnancies, matched for age and smoking habit. Hypertension was defined as ≥140/90 mmHg and classified in chronic, gestational and pre-eclampsia.

Statistical Analysis: Student's t-test, χ², simple, and/or multiple and logistic regression analysis were used when appropriate. Odds ratio was calculated for hypertension. p significant <0.05.

Results: The overall prevalence of hypertension was 40.8% (18.4% chronic, 17.1% gestational and 5.3% pre-eclampsia) in type 2 diabetic pregnancies and 10% (8.3% gestational and 1.7% pre-eclampsia) in normal pregnancies (p<0.0001), with an odds ratio of 6.2. All the types of hypertension, significantly chronic, contributed to the higher prevalence. Only in diabetic pregnancies, hypertension was associated with a higher pregestational BMI; whenever BMI increased, chronic and gestational hypertension increased by contrast of pre-eclampsia (χ², 0.02). Hypertensive disorders did not affect maternal-fetal outcome.

Conclusions: The prevalence of hypertension was 40.8% in type 2 diabetic pregnant women whilst it was 10.0% in non diabetic controls. All hypertensive disorders, significantly chronic, were more frequent. Increasing BMI was a crucial factor for chronic and gestational but not for pre-eclampsia. Hypertensive diseases did not seem to affect pregnancy outcome.

type 2 diabetes mellitus - hypertension - pregnancy

References

• 1 Feig DS, Palda VA. Type 2 diabetes in pregnancy: a growing concern.  Lancet. 2002;  359 1690-1692
• 2 Leahy JL. Pathogenesis of type 2 diabetes mellitus.  Arch Med Res. 2005;  36 197-209
• 3 Solomon CG, Seely EW. Hypertension in pregnancy. A manifestation of the insulin resistance syndrome?.  Hypertension. 2001;  37 232-239
• 4 Sibai B. et al . Pre-eclampsia.  Seminar. 2005;  365 785-799
• 5 Hauner H. et al . Prevalence of undiagnosed Type-2-diabetes mellitus and impaired fasting glucose in German Primary Care: Data from the German Metabolic and Cardiovascular Risk Project (GEMCAS).  Experimental and Clinical Endocrinology & Diabetes. 2008;  116 ((1)) 18-25
• 6 Hadden DR. et al . Poor pregnancy outcome for women with type 2 diabetes.  Diabetic Medicine. 2003;  20 505-509
• 7 Dunne F. et al . Pregnancy in women with type 2 diabetes: 12 years outcome data 1990–2002.  Diabetic Medicine. 2003;  20 734-738
• 8 Clausen TD. et al . Poor pregnancy outcome in women with type 2 diabetes.  Diabetes Care. 2005;  28 323-328
• 9 Isermann B. et al . Autoantibodies in Diabetes Mellitus: Current Utility and Perspectives.  Experimental and Clinical Endocrinology & Diabetes. 2007;  115 ((8)) 483-490
• 10 Weires MB. et al . Familiality of Diabetes Mellitus.  Experimental and Clinical Endocrinology & Diabetes. 2007;  115 ((10)) 634-640
• 11 Metzger BE, Coustan DR. The organizing Committee: Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus.  Diabetes Care. 1998;  21 ((suppl. 2)) B161-B167
• 12 ADA American Diabetes Association . Preconception care of women with diabetes: position statement.  Diabetes Care. 2001;  19 ((suppl. 1)) S25-S28
• 13 Molsted-Pedersen L, Damm P. How to organize care for pregnant diabetic patients. In: Mogensen CE, Standl E, eds. concepts for the ideal diabets clinic. New York, Walter de Gruyter 1999: 199-214
• 14 Giacchi M, Mattei M, Rossi S. Correction of the self-reported BMI in a teenage population.  Int J Obesity Relat Metab Disord. 1998;  22 673-677
• 15 Kuczmarski MF, Kuczmarski RJ, Najjar M. Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988–1994.  J Amer Diet Associat. 2001;  101 28-34
• 16 Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy . Am J Obstet Gynecol. 2000;  183 S1-S22
• 17 Higgins JR, de Swiet M. Blood-pressure measurement and classification in pregnancy.  Lancet. 2001;  357 131-135
• 18 Hypertension in Pregnancy. Guidelines on the detection, investigation and management of hypertension in pregnancy. See: http://www.health.nsw.gov.au/policies/
• 19 Spranger J. et al . Errors of morphogenesis: concepts and terms. Recommendations of an International Working Group.  J Pediatr. 1982;  100 160-165
• 20 Martinez-Frias ML, Frias JP, Bermejo E. et al . Pregestational maternal body mass index predicts an increased risk of congenital malformations in infants of mothers with gestational diabetes.  Diabetic Medicine. 2005;  22 ((6)) 775-781
• 21 Homko CJ. et al . Is there a role for oral antyhyperglycemics in gestational diabetes and type 2 diabetes during pregnancy?.  Treat Endocrinol. 2004;  3 133-139
• 22 Cundy T. et al . Hypertensive disorders of pregnancy in women with type 1 and type 2 diabetes.  Diabetic Medicine. 2002;  19 482-489
• 23 Leinonen A. et al . Diurnal blood glucose profiles in women with gestational diabetes with or without hypertension.  Diabetic Medicine. 2004;  21 1181-1184
• 24 Eckel RH. et al . The metabolic syndrome.  Lancet. 2005;  365 1415-1428
• 25 Ruderman N. et al . The metabolically obese, normal-weight individual revisited.  Diabetes. 1998;  47 ((5)) 699-713
• 26 Savona-Ventura C, Grima S. Hypertensive disorders during pregnancy in gestational diabetic women.  Exp Clin Endocrinol Diabetes. 2008;  116 ((6)) 329-332
• 27 Xiao R. et al . Influence of pre-eclampsia on fetal growth.  J Matern Fetal Neonatal Med. 2003;  13 ((3)) 157-162
• 28 Napoli A. et al . Twenty-four-hour blood pressure monitoring in normoalbuminuric normotensive type 1 diabetic women during pregnancy.  Journal Diabetes Complications. 2003;  17 292-296

Correspondence