Risk factors, pregnancy complications, and prevention of hypertensive disorders in women with pregravid diabetes mellitus.
OBJECTIVE
To review the rate, risk factors, and potential prevention of preeclampsia in women with pregravid diabetes mellitus.


METHODS
Detailed review of recent English literature describing pregnancy outcome in women with pregravid insulin-dependent diabetes mellitus (Type 1 diabetes). The primary focus of the review is risk factors for preeclampsia and potential methods suggested for prevention of preeclampsia. In addition, pitfalls in diagnosis of preeclampsia will be emphasized.


RESULTS
The reported rate of preeclampsia ranged from 9% to 66%. This rate increased with increased severity of diabetes by White's classification, with the highest rate reported in women with pregravid diabetic nephropathy. Risk factors identified for preeclampsia were nulliparity, chronic hypertension, microalbuminuria prior to pregnancy, nephropathy, and poor glycemic control early in pregnancy. There is lack of agreement among reports in the literature concerning criteria used to diagnose preeclampsia. There are two randomized trials that included women with Type 1 diabetes who were randomized to receive either low-dose aspirin or placebo. There was no reduction in the rate of preeclampsia with low-dose aspirin in either trial.


CONCLUSIONS
In women with pregravid Type 1 diabetes, the rates of preeclampsia and adverse neonatal outcome increase with increased severity of diabetes. Low-dose aspirin does not reduce rate of preeclampsia in such women. Further studies should address the role of good glycemic control prior to 20 weeks gestation and prevention of microalbuminuria.
Sibai
B M
BM
Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA. bsibai@utmem.edu
D001241:Aspirin / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control*; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011254:Pregnancy in Diabetics / Q000150:complications*; D012307:Risk Factors
D001241:Aspirin