title: Preeclampsia as a risk factor for diabetes: a population-based cohort study.
abstract: BACKGROUND
  Women with preeclampsia (PEC) and gestational hypertension (GH) exhibit insulin resistance during pregnancy, independent of obesity and glucose intolerance. Our aim was to determine whether women with PEC or GH during pregnancy have an increased risk of developing diabetes after pregnancy, and whether the presence of PEC/GH in addition to gestational diabetes (GDM) increases the risk of future (postpartum) diabetes.
  
  
  RESULTS
  We performed a population-based, retrospective cohort study for 1,010,068 pregnant women who delivered in Ontario, Canada between April 1994 and March 2008. Women were categorized as having PEC alone (n=22,933), GH alone (n=27,605), GDM alone (n=30,852), GDM+PEC (n=1,476), GDM+GH (n=2,100), or none of these conditions (n=925,102). Our main outcome was a new diagnosis of diabetes postpartum in the following years, up until March 2011, based on new records in the Ontario Diabetes Database. The incidence rate of diabetes per 1,000 person-years was 6.47 for women with PEC and 5.26 for GH compared with 2.81 in women with neither of these conditions. In the multivariable analysis, both PEC alone (hazard ratio [HR]=2.08; 95% CI 1.97-2.19) and GH alone (HR=1.95; 95% CI 1.83-2.07) were risk factors for subsequent diabetes. Women with GDM alone were at elevated risk of developing diabetes postpartum (HR=12.77; 95% CI 12.44-13.10); however, the co-presence of PEC or GH in addition to GDM further elevated this risk (HR=15.75; 95% CI 14.52-17.07, and HR=18.49; 95% CI 17.12-19.96, respectively). Data on obesity were not available.
  
  
  CONCLUSIONS
  Women with PEC/GH have a 2-fold increased risk of developing diabetes when followed up to 16.5 years after pregnancy, even in the absence of GDM. The presence of PEC/GH in the setting of GDM also raised the risk of diabetes significantly beyond that seen with GDM alone. A history of PEC/GH during pregnancy should alert clinicians to the need for preventative counseling and more vigilant screening for diabetes. Please see later in the article for the Editors' Summary.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada. d.feig@utoronto.ca
authors.forename: Denice S
authors.initials: DS
authors.lastname: Feig
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.forename: Lorraine L
authors.initials: LL
authors.lastname: Lipscombe
authors.forename: C Fangyun
authors.initials: CF
authors.lastname: Wu
authors.forename: Joel G
authors.initials: JG
authors.lastname: Ray
authors.forename: Julia
authors.initials: J
authors.lastname: Lowe
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Hwee
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Booth
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology*; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced; D015994:Incidence; D007333:Insulin Resistance; D015999:Multivariate Analysis; D011225:Pre-Eclampsia; D011247:Pregnancy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult