title: Pre-eclampsia and pregnancy-induced hypertension are associated with severe diabetic retinopathy in type 1 diabetes later in life.
abstract: To investigate whether pre-eclampsia (PE) or pregnancy-induced hypertension (PIH) predicts the development of severe diabetic retinopathy (SDR) in type 1 diabetes. Altogether, 203 women with type 1 diabetes who were followed during pregnancy were re-examined within the Finnish Diabetic Nephropathy Study. After excluding patients with pre-pregnancy hypertension and those who had had laser treatment or whose retinopathy was graded as proliferative at the index pregnancy, 158 were prospectively studied. As a surrogate marker for SDR, retinal laser photocoagulation was used. The time from pregnancy to SDR (N = 21) or follow-up was 16 years (interquartile range, 11-19). HbA1c was repeatedly measured both during pregnancy and follow-up. Women with prior PE (26 % vs. 6 %, P = 0.003) or PIH (24 % vs. 6 %, P = 0.008) had more often incident SDR during follow-up compared to those with normotensive pregnancy. The hazard ratios (HR) remained associated with the progression to SDR after adjustment for duration of diabetes and diabetic nephropathy in a Cox regression analysis [PE: 3.5 (95 % CI 1.1-10.9); P = 0.03 and for PIH: 3.2 (1.1-9.8); P = 0.04]. The association between PIH and incident SDR did not change after inclusion of mean HbA1c, measured during pregnancy (all 3 trimesters) and serial HbA1c measurements during follow-up, 3.5 (1.1-11.8; P = 0.03). However, in a similar model, the HR for PE was no more significant 2.0 (0.6-6.8; P = NS). The results suggest that women with type 1 diabetes and a hypertensive pregnancy have an increased risk of severe diabetic retinopathy later in life.
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland, dgordin@mappi.helsinki.fi.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gordin
authors.forename: Risto
authors.initials: R
authors.lastname: Kaaja
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
authors.forename: Vilho
authors.initials: V
authors.lastname: Hiilesmaa
authors.forename: Kari
authors.initials: K
authors.lastname: Teramo
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology* / Q000209:etiology; D008028:Light Coagulation / Q000706:statistics & numerical data; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D012307:Risk Factors