title: White's classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study.
abstract: OBJECTIVE
  Our aim was to examine the association of White's classification with obstetric and perinatal risk factors and outcomes in type 1 diabetic patients.
  
  
  METHODS
  Obstetric records of a population-based cohort of 1,094 consecutive type 1 diabetic patients with a singleton childbirth during 1988-2011 were studied. The most recent childbirth of each woman was included.
  
  
  RESULTS
  The prepregnancy and the first trimester HbA1c increased from White's class B to F (p for trend <0.001). Systolic and diastolic blood pressure and pre-eclampsia frequencies increased stepwise from class B to F (p for trends <0.001). Vaginal deliveries decreased and Caesarean sections and deliveries before 37 weeks increased from class B to F (p for trends <0.001). Fetal macrosomia (p for trend=0.003) decreased and small-for-gestational age infants (p for trend=0.002) and neonatal intensive care unit admissions (p for trend=0.001) increased from class B to F. In logistic regression analysis, White's classes were associated with pre-eclampsia but, with the exception of class R (proliferative retinopathy) and F (nephropathy), not with other adverse outcomes when adjusted for first trimester HbA1c ≥7% (≥53 mmol/mol) and blood pressure ≥140/90 mmHg. First trimester HbA1c ≥7% was associated with pre-eclampsia, preterm delivery, fetal macrosomia and neonatal intensive care unit admission.
  
  
  CONCLUSIONS
  White's classification is useful in estimating the risk of pre-eclampsia in early pregnancy independently of suboptimal glycaemic control and hypertension. However, its utility in predicting adverse perinatal outcomes seems limited when information on first trimester HbA1c, blood pressure and diabetic microvascular complications is available.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029, Helsinki, Finland. miira.klemetti@helsinki.fi.|Department of Obstetrics and Gynaecology, South Karelia Central Hospital, Lappeenranta, Finland. miira.klemetti@helsinki.fi.
authors.forename: Miira M
authors.initials: MM
authors.lastname: Klemetti
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029, Helsinki, Finland.|Department of Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.
authors.forename: Hannele
authors.initials: H
authors.lastname: Laivuori
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029, Helsinki, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Tikkanen
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Nuutila
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029, Helsinki, Finland.
authors.forename: Vilho
authors.initials: V
authors.lastname: Hiilesmaa
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029, Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Teramo
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001786:Blood Glucose / Q000032:analysis; D002585:Cesarean Section; D002648:Child; D002851:Chromatography, High Pressure Liquid; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000628:therapy*; D003971:Diastole; D005260:Female; D005320:Fetal Macrosomia / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D015931:Intensive Care, Neonatal / Q000379:methods; D015233:Models, Statistical; D009774:Obstetrics / Q000379:methods*; D011225:Pre-Eclampsia / Q000175:diagnosis; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011254:Pregnancy in Diabetics / Q000175:diagnosis* / Q000628:therapy*; D047928:Premature Birth; D012044:Regression Analysis; D012307:Risk Factors; D013599:Systole; D055815:Young Adult
chemical_list: D001786:Blood Glucose