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Women with Preeclampsia Have Double the Type 2 Diabetes Risk

Posted: Thursday, June 15, 2006

Researchers reported that preeclampsia is an independent risk marker for type 2 diabetes, even when gestational diabetes is taken into account.

Women with a history of preeclampsia have a two-fold greater risk of developing type 2 diabetes compared with women who had no preeclampsia, said Darcy B. Carr, M.D., of the University of Washington in Seattle. The risk for type 2 diabetes remained significant after controlling for the mother's age at delivery, multiparity, and gestational diabetes, said Dr. Carr in a presentation at the American Diabetes Association meeting here.

Preeclampsia is associated with obesity, insulin resistance, dyslipidemia, and endothelial dysfunction, and women with a history of the condition are known to be at increased risk for developing cardiovascular disease, Dr. Carr noted.

To determine whether there could be a similar relationship between preeclampsia and diabetes risk, the investigators conducted a cohort study in a Seattle-area group health cooperative. The women in the cohort included those who delivered at the cooperative during 1985 to 2002. In all, 3,814 of the women had preeclampsia during their pregnancies, and 30,546 did not.
All in the study had been enrolled in the cooperative for at least one year prior to delivery, received subsequent care there, and had no known history of diabetes before the pregnancy, and did not develop type 1 diabetes after the study. Data on type 2 diabetes in the cohort was gathered through 2005 on the basis of inpatient and outpatient ICD-9 codes, pharmacy data for insulin or oral diabetic agents, or from two elevated plasma glucose tests (fasting =126 mg/dL and/or nonfasting =200 mg/dL).
The mean follow-up was 5.4 years. The mean age at delivery in each group was about 30 years. Women in the preeclampsia group were more likely to have had more than one pregnancy (43.8% vs. 38.4%, P<0.001), to have had gestational diabetes (1.3 vs 0.4%; P<0.001), and to have had pre-existing chronic hypertension (3.1% vs 0.1%; P<0.001).

In all, 1.9% of women who had preeclampsia went on to develop type 2 diabetes, compared with 0.96% of women with no preeclampsia. The odds ratio for developing diabetes among those with preeclampsia was 1.97; (95% confidence interval, 1.51-2.56).

When the data were adjusted for age, multiparity, gestational diabetes, and chronic hypertension, the association between preeclampsia and diabetes risk remained strong (odds ratio 1.88; 95% CI 1.42-2.49). The odds ratio was almost identical when the 183 women with gestational diabetes were excluded separately (OR 1.86; 95%CI 1.39-2.48).

The findings suggest, said the investigators, that because women with preeclampsia appear to have a significant risk for developing subsequent type 2 diabetes even in the absence of gestational diabetes, clinicians should consider interventions aimed at improving the patients' overall metabolic and cardiovascular health.

Office Pearl: Explain to patients that preeclampsia is a serious complication of some pregnancies, resulting in hypertension that can be harmful to the mother and her fetus. This study indicates that preeclampsia may also be a risk factor for future type 2 diabetes.



Source: Diabetes In Control: 2006 American Diabetes Association Scientific Sessions: Carr DB et al. "Women with a History of Preeclampsia Have an Increased Risk of Developing Type 2 Diabetes." Abstract 80-OR, presented June 10.

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