Preeclampsia increases risk of developing postpartum diabetes

Women with preeclampsia have a two-fold increased risk of developing postpartum diabetes according to recent research by scientists at the Institute for Clinical Evaluative Sciences (ICES) and Mount Sinai Hospital in Toronto. Preeclampsia is marked by the development of high blood pressure and protein in the urine after the twentieth week of pregnancy. Women with preeclampsia and gestational hypertension exhibit insulin resistance during pregnancy, independent of obesity and glucose intolerance.

In this population-based study, the presence of preeclampsia or gestational hypertension was associated with a two-fold increased incidence of diabetes (6.47 per 1,000 person-years for women with preeclampsia, 5.26 per 1,000 person-years for women with gestational hypertension, versus 2.81 per 1,000 person-years in those without either) within the first decade following pregnancy.

“In the setting of gestational diabetes, the additional presence of preeclampsia or gestational hypertension was associated with a further elevation in diabetes risk over and above the already substantial increase resulting from gestational diabetes alone,” says lead author, Dr. Denice Feig, ICES scientist, associate professor at the University of Toronto, and head of the diabetes in pregnancy program at Mount Sinai Hospital.

This risk was even higher in the setting of preterm delivery, suggesting that diabetes incidence rises with increasing severity of these hypertensive disorders.

About this study:

• The study followed 1,010,068 pregnant women aged 15 to 50 years who delivered in an Ontario hospital between April 1, 1994, and March 31, 2008.
• Women with a diagnosis of diabetes before their pregnancy were identified and excluded.
• The range of follow-up was 1 day to 16.5 years, with a median follow-up of 8.5 years.
• Overall, 35,077 women developed diabetes (3.5 per cent).

Women with either preeclampsia or gestational hypertension were two times as likely to develop diabetes. Women with gestational diabetes were 12 times as likely to develop diabetes; however, this rose to 15 to 18 times in the presence of preeclampsia or gestational hypertension.

These findings highlight a new risk factor for diabetes and support the need to counsel patients with hypertensive disorders of pregnancy regarding postpartum diabetes screening prevention.

“A history of preeclampsia during pregnancy should alert clinicians to the need for preventative counselling and more vigilant screening for diabetes,” says Feig.

Background:

The prevalence of type 2 diabetes is increasing dramatically worldwide particularly in adults under the age of 50, including young women. Type 2 diabetes can be prevented or delayed in high-risk groups by a variety of lifestyle and therapeutic interventions. Gestational diabetes is a major risk factor for the development of diabetes and thus women with this condition are an ideal population to target diabetes prevention strategies to. Similarly, other disorders of pregnancy associated with insulin resistance like preeclampsia may increase the risk for women to develop diabetes in the years following pregnancy, and such women may be suitable targets for diabetes prevention.

Hypertensive disorders in pregnancy, including gestational hypertension and preeclampsia, affect approximately 8 per cent of all pregnancies. More recently, women with gestational hypertension and preeclampsia have been noted to exhibit insulin resistance during pregnancy that is independent of obesity and glucose intolerance. The aim of this study was to investigate whether other disorders of pregnancy associated with insulin resistance like preeclampsia and gestational hypertension may increase the risk for women to develop diabetes in the years following pregnancy. The research suggests that such women may be suitable targets for diabetes prevention.

The study “Preeclampsia as a risk factor for diabetes; a population based cohort study” is in the April 16, 2013, issue of PLOS Medicine.

 Author block: Denice S. Feig, Baiju R. Shah, Lorraine L. Lipscombe, C. Fangyun Wu, Joel G. Ray, Julia Lowe, Jeremiah Hwee, Gillian L. Booth.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

Mount Sinai Hospital is as an internationally recognized 446-bed acute care academic health sciences centre affiliated with the University of Toronto that is dedicated to delivering the best medicine and best patient experience. It is focused on excellence in patient and family-centred care, innovative education and leading-edge research. Clinical strengths include women’s and infants’ health, chronic disease management, specialized cancer, emergency and acute medicine, and geriatrics. The hospital has been designated with Exemplary Status from Accreditation Canada and every aspect of patient care is anchored in a rigorous quality plan and monitoring of safety and quality goals. Mount Sinai’s Samuel Lunenfeld Research Institute ranks in the top 2.5% of biomedical research institutes in the world. The Hospital is considered to be a top employer in Canada, receiving multiple awards for its employment and culture centred programs. www.mountsinai.ca.

This study was funded by the Canadian Diabetes Association. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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