Preeclampsia, Gestational Hypertension Raise Diabetes Risk

Having preeclampsia (PEC) or gestational hypertension (GH) doubles women's risk of

developing postpartum diabetes compared with those who do not have these conditions, a new
study has revealed.
Furthermore, gestational diabetes (GD) is associated with a nearly 13 times increased risk of
developing postpartum diabetes, according to an analysis of health information from more than
one million women who delivered babies in Ontario, Canada, from April 1994 to March 2008.
The investigators, who reported their findings in PLOS Medicine (2013;10:e1001425), were
surprised at the magnitude of increased risk for diabetes conferred by these conditions. They
recommend that health care providers screen their pregnant patients for a history of preeclampsia
or gestational hypertension.

Also, they should screen their female patients regularly for diabetes, and counsel them to
maintain a normal weight and exercise regularly because this may prevent the onset of diabetes,
lead investigator Denice Feig, MSc, told Renal & Urology News.
Dr. Feig is a scientist with the Institute for Clinical Evaluative Sciences in Toronto, and the head
of the Mount Sinai Hospital's Diabetes & Endocrinology in Pregnancy Program. Her team
conducted the study because previous research showed women with PEC and GH also have
insulin resistance, and PEC/GH is associated with other disorders linked to intrapartum insulin
resistance.
The team identified women with PEC, GH or GD from the Canadian Institute for Health
Information Discharge Abstract Database and excluded those with pre-existing diabetes or
hypertension. They analyzed the resulting 1,010,068 women's records.
The available information did not include obesity level or other factors known to be associated
with the development of diabetes such as family history and amount of physical activity. It also
did not indicate whether the cases of postpartum diabetes were type 1 or type 2; however, the
investigators believe most cases were likely to be type 2 because of the age of the women in the
study.
The number of women who would have to be followed for five years to detect one case of
diabetes was 4,511 with GH alone, 123 for PEC alone, 68 for GD alone, 31 for GD plus PEC and
105 for GD plus GH.
The 30,852 women with GD were significantly older than those without this condition, and also
had lower incomes. Moreover, they were more likely to have pre-existing hypertension and
comorbidities.
The researchers performed a multivariate analysis that involved adjustment for age, income
quintile, pre-existing hypertension, and comorbidities. This revealed that PEC alone and GH
alone are associated with a twofold higher risk of developing diabetes. GD alone is associated
with a 12.8 times increased risk. GD plus PEC is associated with a 15.7 times increased risk and
GD plus GH are associated with an 18.5 times increased risk.
The highest risk was found in women with GD, PEC, and preterm delivery: their risk was 30.7
times greater than that of pregnant women without GD, GH or PEC.
Adjustment for parity strengthened these associations further. For example, the risk of
developing diabetes was increased 16.6-fold in women with GD alone, 22.5-fold for women with
GD plus PEC, and 23.5-fold for GD plus GH.
The study also showed that among women with GH plus PEC the risk for developing diabetes
was stable out to the median follow-up time of 8.5 years. Those with GD alone or together with
GH or PEC had a decreased risk over time of developing diabetes after pregnancy compared
with pregnant women without GH, PEC or GD. The latter finding may be due to early
development of diabetes among those who are at the highest risk, Dr. Feig's team hypothesized,
noting this is consistent with the natural history of postpartum diabetes.

Reaction:
If you develop high blood pressure after 20 weeks of pregnancy but don't have protein in your
urine, you'll be diagnosed with gestational hypertension, sometimes called pregnancy-induced
hypertension (PIH). (Women who develop high blood pressure after midpregnancy and have
protein in their urine have a complex disorder calledpreeclampsia, and those who had high blood
pressure before pregnancy or are diagnosed with it before 20 weeks have what's
called chronic hypertension.)

High blood pressure is generally defined as a reading of 140/90 or higher, even if only one of the
numbers is elevated. It doesn't usually cause any noticeable symptoms unless the blood pressure
is really high.
The good news is that most women who get gestational hypertension have only a mild form of
the condition and don't develop it until near term (37 weeks or later). If you're in this category,
you still have a somewhat higher risk of being induced or having a c-section, but other than that,
you and your baby are likely to do as well as you would if you had normal blood pressure.