Usefulness of ambulatory blood pressure monitoring in pregnant women with type 1 diabetes.
OBJECTIVE
Pregnancy in type 1 diabetes is associated with an increased risk of developing pregnancy-induced hypertension (PIH). Ambulatory blood pressure monitoring (ABPM) has been used to screen for preeclampsia in nondiabetic pregnancy. To date, there are no data regarding ABPM during pregnancy in normotensive type 1 diabetic women. This study sought to establish blood pressure (BP) profiles for pregnant type 1 diabetic women using ABPM and determine whether the BP pattern can define a population at risk for developing PIH.


METHODS
ABPM was carried out for one 24-h period during each trimester--in the first trimester between weeks 7 and 12, in the second trimester between weeks 20 and 24, and in the third trimester between weeks 30 and 34--in 22 normotensive pregnant type 1 diabetic and 10 pregnant nondiabetic women.


RESULTS
The incidence of PIH was fourfold greater in type 1 diabetic women than in control subjects. Diabetic women showed higher daily diastolic BP in the third trimester compared with nondiabetic pregnant women. Diabetic women who developed PIH in the third trimester showed significantly higher BP profiles throughout gestation than those who remained normotensive. Receiver operator characteristics curves for nighttime systolic BP showed the best predictive capacity for PIH, with a cutoff > 105 mmHg (85% sensitivity and 92% specificity).


CONCLUSIONS
Our study confirms the early increase of BP in patients who will develop PIH and suggests that nighttime systolic BP >105 mmHg in the second trimester is a useful predictor of PIH. ABPM may be useful in screening for PIH in pregnant diabetic women.
Flores
L
L
Servei d'Endocrinologia i Diabetes, Hospital Clínic, Facultat Medicina, Universitat de Barcelona, Spain.
Levy
I
I
Aguilera
E
E
Martinez
S
S
Gomis
R
R
Esmatjes
E
E
D000293:Adolescent; D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000209:etiology; D011264:Pregnancy Trimesters; D011254:Pregnancy in Diabetics / Q000503:physiopathology / Q000628:therapy*; D012372:ROC Curve; D012307:Risk Factors