[Effect of pregnancy on diabetic vascular complications].
OBJECTIVE
There are still controversies referring to pregnancy influence on the development of vascular complications in type 1 diabetes.


METHODS
227 diabetic women were taken into the study (109 who gave at least one birth (GB) and 118, who never were pregnant (NB)). All of patients started to be diabetic before the 15 years of age. We compared the development of vascular complications (VC) (hypertension-RR, proteinuria (P), retinopathy (R) and the age of patients, HbA1C, serum creatinine (Cr), creatinine clearance (CrCl) between the GB and NB groups. We also compared the development of VC in relation to risk factors (RF): HbA1c and duration of diabetes.


RESULTS
Women who gave birth were significantly older and developed diabetes earlier than childless women. We didn't find any significant difference in duration of diabetes, HbA1c, mean blood pressure (BP), Cr and CrCl between these two groups. In the GB group in comparison to NB we noticed higher frequency of RR (11.1% vs 6.8%, OR 1.7), proliferative retinopathy (9% vs 6.8%, OR 1.4) and laser therapy (5.5% vs 3.4%, OR 1.6). In the next step we analyzed the development of VC in relation to risk factors: duration of diabetes (less or more than 20 years) and HbA1c levels (below and above 8.0%). Patients, who developed diabetes before 20 years of age were significantly older (36.3 vs 31.2 years p < 0.001), duration of diabetes in this group was longer (26 vs 14 years p < 0.001), Cr was higher (0.9 mg/dl vs 0.8 mg/dl p < 0.05)and CrCl was lower (73 mg/ml vs 86 mg/ml p < 0.05). In this group the frequency of proteinuria as well as retinopathy were higher (18.2% vs 7.9%, OR 2.59) (52% vs 9.2%, OR 10.6). We didn't find the difference in HbA1c concentration between the groups with different duration of diabetes. Higher HbA1c presented no relation to the age of patients, but correlated with lower frequency of patients without retinopathy (60.3% vs 66% OR 0.68). In this group laser therapy had to be performed more frequent (6.8% vs 1.8% OR 6.1).


CONCLUSIONS
Pregnancy in diabetic patients with good metabolic control doesn't seem to be a risk factor for developing vascular complications. These complications are still strongly correlated with duration of diabetes.
Wender-Ozegowska
Ewa
E
Klinika Połoznictwa i Chorób Kobiecych Katedry Ginekologii i Połoznictwa, AM im. K. Marcinkowskiego w Poznaniu. ewaoz@post.pl
Zawiejska
Agnieszka
A
Pietryga
Marek
M
Zozulińska
Dorota
D
Wierusz-Wysocka
Bogna
B
Chmaj
Karolina
K
Biczysko
Romuald
R
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003404:Creatinine / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology* / Q000503:physiopathology; D011254:Pregnancy in Diabetics / Q000150:complications* / Q000503:physiopathology; D011507:Proteinuria / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors
D003404:Creatinine; D006442:Glycated Hemoglobin