Preeclampsia and diabetes mellitus

Download PDF Czech version

Authors: Markéta Hornová; P. Šimják; K. Anderlová
Authors‘ workplace: Klinika gynekologie, porodnictví a neonatologie 1. LF UK a VFN v Praze
Published in: Ceska Gynekol 2023; 88(6): 467-471
Category:

Overview

Objective: The purpose of this paper is to provide a review of recent research on the relationship between preeclampsia and diabetes mellitus in pregnancy. Methodology: A structured search for literary sources in PubMed and ScienceDirect databases using keywords, followed by a selection of papers based on solid methodology. Results: Preeclampsia is a serious condition, which complicates 2–7% of pregnancies. It causes maternal complications (organ dysfunction) and fetal complications (pathological haemodynamic parameters of the uteroplacental unit and fetal growth restriction). Pregnant women with pregestational diabetes have a 2- and 4-times higher risk of developing preeclampsia and the ones with gestational diabetes have 1.3-times higher risk. The main identified risk factors are inadequate compensation of diabetes, diabetic nephropathy, retinopathy and the duration of diabetes. To minimalize the risk of developing preeclampsia, a composite screening has been implemented. With a positive result a preventive use of acetylsalicylic acid from at the latest 16 and up until the 36^th week is advised. Preeclampsia is also a risk factor for developing diabetes mellitus and other cardiovascular diseases later in life. For that reason, a long-term dispensary of women who had preeclampsia in pregnancy is recommended.

Keywords:

Proteinuria – preeclampsia – gestational diabetes mellitus – acetylsalicylic acid – pregestational diabetes mellitus – uteroplacental insufficiency – late complications of preeclampsia

Sources

1. Roubalová L, Vojtěch J, Feyereisl J et al. Screening preeklampsie v 1. trimestru těhotenství. Ceska Gynekol 2019; 84 (5): 361–370.

2. Sibai B M, Caritis S, Hauth J et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol 2000; 182 (2): 364–369. doi: 10.1016/s0002-9378 (00) 70225-0.

3. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009; 33 (3): 130–137. doi: 10.1053/j.semperi.2009.02.010.

4. Doporučené postupy ČGPS ČLS JEP. Management hypertenzních onemocnění v těhotenství. Revize doporučeného postupu z roku 2009. In: Měchurová A, Andělová K (eds). Hypertenze v graviditě. Ceska Gynekol 2013; 78 (Suplementum): 45–47.

5. von Schmidt auf Altenstadt JF, Hukkelho ven CW, van Roosmalen J et al. Pre-eclampsia increases the risk of postpartum haemorrhage: a nationwide cohort study in the Netherlands. PLoS One 2013; 8 (12): e81959. doi: 10.1371/journal.pone.0081959.

6. Melchiorre K, Giorgione V, Hilaganathan B. The placenta and preeclampsia: villain or victim? Am J Obstet Gynecol 2022; 226 (2S): S954–S962. doi: 10.1016/j.ajog.2020.10.024.

7. Hiilesmaa V, Suhonen L, Teramo K. Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with type I diabetes mellitus. Diabetologia 2000; 43 (12): 1534–1539. doi: 10.1007/s001250051565.

8. Fishel MF, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical signifikance. Am J Obstet Gynecol 2022; 226 (2S): S819–S834. doi: 10.1016/j.ajog.2020.08.108

9. Mosca LJ. Benjamin EJ, Berra K et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women – 2011 update: a guidelines from the American Heart Association. J Am Coll Cardiol 2011; 57 (12): 1404–1423. doi: 10.1016/j.jacc.2011.02.005.

10. Weissgerber TL, Mudd LM. Preeclampsia and diabetes. Curr Diab Rep 2015; 15 (3): 9. doi: 10.1007/s11892-015-0579-4.

11. Magee LA, Brown MA, Hall DR et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, dia g nosis & management recommendations for international practice. Pregnancy Hypertens 2022; 27: 148–169. doi: 10.1016/j.preghy.2021.09.008.

12. Adkins K, Allshouse AA, Metz T et al. Impact of aspirin on fetal growth in diabetic pregnancies according to White classification. Am J Obstet Gynecol 2017; 217 (4): 465.e1–465.e5. doi: 10.1016/j.ajog.2017.05.062.

13. Damm P, Mersebach H, Råstam J et al. Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA_1c and spikes of high glucose values in the third trimester. J Matern Fetal Neonatal Med 2014; 27 (2): 149–154. doi: 10.3109/14767058.2013.806896.

14. Rolnik DL, Wright D, Poon LC et al. ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol 2017; 50 (4): 492–495. doi: 10.1002/uog.18816.

15. Krejčí H. Gestační diabetes mellitus. Vnitř Lék 2016; 62 (Suppl 4): 52–61.

16. Gordin D, Kaaja R, Forsblom C et al. Pre-eclampsia and pregnancy-induced hypertension are associated with severe diabetic retinopath in type 1 diabetes later in life. Acta Diabetol 2013; 50 (5): 781–787. doi: 10.1007/s00592-012-0415-0.

17. Schneider S, Freerksen N, Röhrig S et al. Gestational diabetes and preeclampsia – similar risk factor profiles? Early Hum Dev 2012; 88 (3): 179–184. doi: 10.1016/j.earlhumdev.2011.08.004.

18. Colatrella A, Loguercio V, Mattei L et al. Hypertension in diabetic pregnancy: impact and long-term outlook. Best Pract Res Clin Endocrinol Metab 2010; 24 (4): 635–651. doi: 10.1016/j.beem.2010.05.003.

19. Valensise H, Vasapollo B, Gagliardi G et al. Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease. Hypertension 2008; 52 (5): 873–880. doi: 10.1161/HYPERTENSIONAHA.108. 117358.

20. Doporučené postupy ČGPS ČLS JEP. Porod velkého plodu. Ceska Gynekol 2016; 81 (2): 92.

21. Bujold E, Tapp S, Audibert F et al. Prevention of adverse pregnancy outcomes with low-dose ASA in early pregnancy: new perspectives for future randomized trials. J Obstet Gynaecol Can 2011; 33 (5): 480–483. doi: 10.1016/S1701-216 3 (16) 34882-4.

22. Vlk R, Matěcha J, Drochýtek V. Prevence preeklampsie – přehledový článek. Ceska Gynekol 2015; 80 (3): 229–235.

23. Chaemsaithong P, Cuenca-Gomez D, Plana MN et al. Does low-dose aspirin initiated before 11 weeks‘ gestation reduce the rate of preeclampsia? Am J Obstet Gynecol 2020; 222 (5): 437–450. doi: 10.1016/j.ajog.2019.08.047.

24. Nuzzo AM, Giuffrida D, Morreti L et al. Placental and maternal sFlt1/PlGF expression in gestational diabetes mellitus. Sci Rep 2021; 11 (1): 2312. doi: 10.1038/s41598-021-81785-5.

25. Vojtaššáková D, Vojtaššák Š. Prvotrimestrálny kombinovaný skríning preeklampsie. Actual Gyn 2021; 13: 9–16.

26. Verlohren S, Brennecke SP, Galindo A et al. Clinical interpretation and implementation of the sFlt-1/PlGF ratio in the prediction, dia g nosis and management of preeclampsia. Pregnancy Hypertens 2022; 27: 42–50. doi: 10.1016/ j.preghy.2021.12.003.

27. Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early – versus late-onset disease. Am J Obstet Gynecol 2013; 209 (6): 544.e1–544.e12. doi: 10.1016/j.ajog.2013.08.019.

28. Homer CS, Brown MA, Mangos G et al. Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension. J Hypertens 2008; 26 (2): 295–302. doi: 10.1097/HJH.0b013e3282f1a953.

29. Nirupama R, Divyashree S, Janhavi P et al. Preeclampsia: pathophysiology and management. J Gynecol Obstet Hum Reprod 2021; 50 (2): 101975. doi: 10.1016/j.jogoh.2020.101 975.