Preeclampsia as a risk factor for diabetes: a population-based cohort study
Feig DS, Shah BR, Lipscombe LL, Wu CF, Ray JG, Lowe J, Hwee J, Booth Gl. PLoS Med. 2013; 10(4):e1001425. Epub 2013 Apr 16.
Background — Women with preeclampsia (PEC) and gestational hypertension (GH) exhibit insulin resistance during pregnancy, independent of obesity and glucose intolerance. The authors' 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 postpartum diabetes.
Methods and Findings — The authors 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). The study's main outcome was a new diagnosis of diabetes postpartum 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. In the multivariable analysis, both PEC alone (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 was not available.
Conclusions — Women with PEC/GH have a 2–fold increased risk of developing diabetes in the 16.5 years following 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.
View full text