Microalbuminuria, preeclampsia and preterm delivery in pregnant women with type 1 diabetes - results from a nation-wide Danish study.

  1. Dorte M. Jensen, PhD (dortemj{at}dadlnet.dk)a,
  2. Peter Damm, DMScb,
  3. Per Ovesen, DMScc,
  4. Lars Mølsted-Pedersen, DMScd,
  5. Henning Beck-Nielsen, DMSca,
  6. Jes G. Westergaard, DMSce,
  7. Margrethe Moeller, MDf and
  8. Elisabeth R. Mathiesen, DMScb
  1. aDept. of Endocrinology, Odense University Hospital, University of Southern Denmark
  2. bCenter for Pregnant Women with Diabetes, Depts. of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen
  3. cDept. of Obstetrics and Gynecology, Aarhus University Hospital, Skejby
  4. dDept. of Obstetrics and Gynecology, Copenhagen County Hospital, University of Copenhagen
  5. eDept. of Obstetrics and Gynecology, Odense University Hospital
  6. f Dept. of Obstetrics and Gynecology, Aalborg University Hospital

    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: Population-based prospective study in 846 normo- or microalbuminuric women with type 1 diabetes without antihypertensive treatment in early pregnancy. Data were collected prospectively by 1-3 caregivers in each center and reported to a central registry.

    Results: The prevalence of microalbuminuria in the first trimester was 10%, median diabetes duration 11 years and 3rd trimester HbA1c 6.6 %. The frequency of preeclampsia and preterm delivery before 34 weeks in the microalbuminuric group was 40% and 13%, both significantly higher than in the normoalbuminuric group where the figures were 12% and 6% respectively (p<0.001). After adjustments for possible confounders, significant predictors for development of preeclampsia were: Microalbuminuria 4.0 (2.2-7.2) (odds ratio, 95% confidence interval), nulliparity 3.1 (1.9-5.1) and 3rd trimester HbA1c 1.3 (1.1-1.5) per 1 % increase.

    Delivery before 34 weeks was associated with early microalbuminuria in univariate analyses, but in multiavariate analyses Hba1c was the only significant predictor of this outcome. Preeclampsia was associated with a threefold higher risk of delivery before 34 weeks.

    Conclusions: Presence of microalbuminuria in early pregnancy is associated with a four-fold increased risk of developing preeclampsia. Hba1c 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

      • Received July 3, 2009.
      • Accepted October 11, 2009.

    This Article

    1. Diabetes Care
    1. All Versions of this Article:
      1. dc09-1219v1
      2. 33/1/90 most recent