title: The risk of preeclampsia beyond the first pregnancy among women with type 1 diabetes parity and preeclampsia in type 1 diabetes.
abstract: OBJECTIVE
  To estimate the incidence of preeclampsia (PE) among nulliparous and multiparous patients with type 1 diabetes and to study predictors of PE.
  
  
  METHODS
  We prospectively collected data on all pregnancies of patients with pregestational type 1 diabetes, followed at our Prenatal Medicine Unit between 1993 and 2008. Medical records were prospectively reviewed by two obstetricians for maternal demographics, pregnancy data, maternal and fetal outcomes. Data were analyzed according to the development of PE and parity.
  
  
  RESULTS
  We identified and collected data on 291 eligible pregnancies (195 among nulliparae and 96 among multiparae). The incidence of PE was 9.2% (95% CI: 5.6-14.2) among nulliparae and 9.4% (95% CI: 4.4-17.0) among multiparae. Patients who developed PE had higher HbA1c during pregnancy compared to patients who did not (p=0.026 among nulliparae and p=0.032 among multiparae). Chronic hypertension [OR 17.12 (3.22, 91.00)], microalbuminuria at the beginning of the pregnancy [OR 3.77 (1.22, 11.61)], weight gain during pregnancy [OR 1.13 (1.04, 1.23)] and HbA1c in the first trimester [2.81 (1.12, 7.05)], but not parity, were significant predictors of PE.
  
  
  CONCLUSIONS
  Among patients with type 1 diabetes the incidence of PE was similar among nulliparae and multiparae, unlikely in the general population where PE is a disease of the first pregnancy. An increased risk of PE should be assumed for both nulliparous and multiparous women with pregestational diabetes.
authors.affiliation: Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: M T
authors.initials: MT
authors.lastname: Castiglioni
authors.affiliation: Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Valsecchi
authors.affiliation: Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cavoretto
authors.affiliation: Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Pirola
authors.affiliation: Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Di Piazza
authors.affiliation: Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Maggio
authors.affiliation: Department of Medicine, San Raffaele Scientific Institute and Univerisità Vita-Salute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Caretto
authors.affiliation: Department of Medicine, San Raffaele Scientific Institute and Univerisità Vita-Salute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: T S
authors.initials: TS
authors.lastname: Garito
authors.affiliation: Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Rosa
authors.affiliation: Diabetes Research Institute, San Raffaele Scientific Institute, via Olgettina, 60, 20132 Milan, Italy. Electronic address: scavini.marina@hsr.it.
authors.forename: M
authors.initials: M
authors.lastname: Scavini
keywords: Diabetes mellitus type 1; Preeclampsia; Pregnancy