Microalbuminuria, Preeclampsia, and Preterm Delivery in Pregnant Women With Type 1 Diabetes
Results from a nationwide Danish study
- Dorte M. Jensen, PHD1,
- Peter Damm, DMSC2,
- Per Ovesen, DMSC3,
- Lars Mølsted-Pedersen, DMSC4,
- Henning Beck-Nielsen, DMSC1,
- Jes G. Westergaard, DMSC5,
- Margrethe Moeller, MD6 and
- Elisabeth R. Mathiesen, DMSC2
- 1Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark;
- 2Departments of Endocrinology and Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;
- 3Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark;
- 4Department of Obstetrics and Gynecology, Copenhagen County Hospital, University of Copenhagen, Copenhagen, Denmark;
- 5Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark;
- 6Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.
- Corresponding author: Dorte M. Jensen, dortemj{at}dadlnet.dk.
Abstract
OBJECTIVE To study the association between microalbuminuria and development of preeclampsia and preterm delivery in pregnant women with type 1 diabetes.
RESEARCH DESIGN AND METHODS This was a population-based prospective study in 846 normoalbuminuric or microalbuminuric women with type 1 diabetes without antihypertensive treatment in early pregnancy. Data were collected prospectively by one to three caregivers in each center and reported to a central registry.
RESULTS The prevalence of microalbuminuria in the first trimester was 10%, median diabetes duration was 11 years, and third-trimester A1C was 6.6%. The frequencies of preeclampsia and preterm delivery before 34 weeks in the microalbuminuric group were 40 and 13%, both significantly higher than those in the normoalbuminuric group (12 and 6%, respectively, P < 0.001). After adjustments for possible confounders, significant predictors for development of preeclampsia were microalbuminuria (odds ratio 4.0 [95% CI]), nulliparity (3.1 [1.9–5.1]), and third-trimester A1C (1.3 [1.1–1.5] per 1% increase). Delivery before 34 weeks was associated with early microalbuminuria in univariate analyses, but in multivariate analyses A1C was the only significant predictor of this outcome. Preeclampsia was associated with a threefold higher risk of delivery before 34 weeks.
CONCLUSIONS The presence of microalbuminuria in early pregnancy is associated with a fourfold increased risk of developing preeclampsia. A1C values during pregnancy are highly predictive of both preeclampsia and preterm delivery. Future research with antihypertensive treatment in normotensive, microalbuminuric pregnant women to prevent preeclampsia is proposed.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received July 3, 2009.
- Accepted October 11, 2009.
- © 2010 by the American Diabetes Association.
