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Preeclampsia as a risk factor for diabetes: a population-based cohort study

Published: April 16, 2013
Category: Papers
Authors: Booth GL, Feig DS, Hwee J, Lipscombe LL, Lowe J, Ray JG, Shah BR, Wu CF
Country: Canada
Language: null
Type: Population Health
Settings: Academic, PCP

PLoS Med 10:e1001425.

Department of Medicine, University of Toronto, Toronto, ON, Canada

BACKGROUND: Women with preeclampsia (PEC) and gestational hypertension (GH) exhibit insulin resistance during pregnancy, independent of obesity and glucose intolerance. Our 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 future (postpartum) diabetes.

METHODS AND FINDINGS: We 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). Our main outcome was a new diagnosis of diabetes postpartum in the following years, 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 of these conditions. In the multivariable analysis, both PEC alone (hazard ratio [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 were not available.

CONCLUSIONS: Women with PEC/GH have a 2-fold increased risk of developing diabetes when followed up to 16.5 years after 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. Please see later in the article for the

Comment in: Diabetes: Pre-eclampsia: association with increased risk of diabetes.Allison SJ. Nat Rev Nephrol. 2013 Jul; 9(7):372. Epub 2013 May 7.

PMID: 23610560
PMCID: PMC3627640

Medical Conditions,Predictive Risk Modeling,Co-morbidity,Morbidity Patterns,Canada,Adult,Cohort Studies,Diabetes Mellitus,Type 2/epidemiology,Gender,Incidence,Insulin Resistance,Multivariate Analysis,Pregnancy,Proportional Hazards Models,Retrospective Studies,Risk Factors,Young Adult

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