Prepregnancy Diabetes and Risk of Placental Vascular Disease
- Taryn Becker, MD, FRCPC1,
- Marian J. Vermeulen, BSCN, MHSC2,
- Philip R. Wyatt, MD, FRCPC, PHD3,
- Chris Meier, BSC, MBA4 and
- Joel G. Ray, MD, MSC, FRCPC5
- 1Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- 2Institute for Clinical Evaluative Sciences, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- 3Department of Genetics, York Central Hospital, Richmond Hill, Ontario, Canada
- 4St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- 5Divisions of Endocrinology and Metabolism and General Internal Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Address correspondence and reprint requests to Dr. Taryn Becker, c/o Dr. Joel G. Ray, St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, Ontario, Canada M5B 1W8. E-mail: rayj{at}smh.toronto.on.ca
Maternal diabetes before pregnancy is associated with adverse maternal and perinatal outcomes, including acquired hypertension during pregnancy (1,2,3). The maternal placental syndromes preeclampsia and abruption or infarction of the placenta (4) are also more prevalent in women with insulin resistance, diabetes, and the metabolic syndrome (3,5–8). We evaluated the risk of placental vascular disease in association with prepregnancy diabetes.
RESEARCH DESIGN AND METHODS—
We completed a retrospective population-based study of all women who underwent antenatal maternal serum screening (MSS) in Ontario, Canada, between 1993 and 2000, as described elsewhere (9). Those with a multiple gestation pregnancy at the time of MSS were excluded.
Maternal characteristics (Table 1) were recorded on a standardized form and completed by the patients’ caregivers at the time of MSS. Data on obstetrical outcomes and the health status of each newborn were also linked to the Discharge Abstract Database of the Canadian Institute for Health Information, providing up to eight ICD-9 diagnostic codes for each woman and each newborn (see the online appendix [available at http://dx.doi.org/10.2337/dc07-0364]).
The primary study outcome was a diagnosis of either preeclampsia and abruption or infarction, according to the relevant ICD-9 codes recorded at the delivery hospital (online appendix). Secondary study outcomes included an individual diagnosis of preeclampsia and abruption or infarction, maternal preeclampsia/eclampsia, and poor fetal growth or fetal growth restriction.
Statistical analysis
The association between prepregnancy diabetes …
