Hypertensive pregnancy disorders linked to diabetes
medwireNews: Women who are diagnosed with pre-eclampsia or hypertension during pregnancy are at increased risk for developing diabetes, particularly if they experience these conditions alongside gestational diabetes, research shows.
"These findings have important implications for maternal health, especially given the increase in obesity-related diseases," say study authors Denise Feig (University of Toronto, Ontario, Canada) and colleagues.
"A history of [pre-eclampsia] or [gestational hypertension] during pregnancy should alert clinicians to the need for preventative counseling and more vigilant screening for diabetes."
The study included 1,010,068 women who gave birth between April 1994 and March 2008. Overall, 22,933 women had pre-eclampsia , 27,605 had gestational hypertension , and 30,852 had gestational diabetes , while 1476 had gestational diabetes and pre-eclampsia, and 2100 had gestational diabetes and hypertension.
Over a median follow up of 8.5 years, 35,077 (3.5%) women developed diabetes, the authors report in PLOS Medicine.
In adjusted analyses, women with gestational hypertension or pre-eclampsia had double the risk for developing diabetes in the 16.5 years following delivery, compared with women who did not have these conditions during pregnancy.
As expected, women with gestational diabetes had a markedly increased risk for diabetes (hazard ratio [HR]=12.8) but this was even greater when these women had also experienced gestational hypertension (HR = 18.5) or pre-eclampsia (HR = 15.8).
The authors also noted a trend toward greater incidence of diabetes among women with pre-eclampsia who also had a preterm delivery, such that women with gestational diabetes, pre-eclampsia, and preterm delivery were at a 30.7-fold increased risk compared with women without any of these conditions.
Both pre-eclampsia and gestational hypertension are associated with insulin resistance during and after pregnancy, and have also been linked to the metabolic syndrome, explain Feig and colleagues. Additionally, endothelial dysfunction and markers of chronic vascular inflammation, which precede the development of hyperglycemia, have been observed in women with pre-eclampsia and gestational diabetes.
Writing in an accompanying editorial, Thach Tran, from the University of Adelaide in South Australia, says that there is not currently enough evidence to support routine postpartum screening for diabetes in women with hypertensive disorders during pregnancy.
Nevertheless, "current postpartum screening programs should particularly focus on women with [gestational diabetes] in combination with hypertensive disorders," Tran says.
"Given their higher risk of developing diabetes, it is crucial to exercise more efforts to improve compliance of this high-risk population to the current postpartum screening for diabetes."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter