Women
with preeclampsia (PEC) and gestational hypertension (GH) exhibit
insulin resistance during pregnancy, independent of obesity and glucose
intolerance. Our aim was to determine whether women with PEC or GH
during pregnancy have an increased risk of developing diabetes after
pregnancy, and whether the presence of PEC/GH in addition to gestational
diabetes (GDM) increases the risk of future (postpartum) diabetes.
Methods and Findings
We
performed a population-based, retrospective cohort study for 1,010,068
pregnant women who delivered in Ontario, Canada between April 1994 and
March 2008. Women were categorized as having PEC alone (n = 22,933), GH alone (n = 27,605), GDM alone (n = 30,852), GDM+PEC (n = 1,476), GDM+GH (n = 2,100), or none of these conditions (n
= 925,102). Our main outcome was a new diagnosis of diabetes postpartum
in the following years, up until March 2011, based on new records in
the Ontario Diabetes Database. The incidence rate of diabetes per 1,000
person-years was 6.47 for women with PEC and 5.26 for GH compared with
2.81 in women with neither of these conditions. In the multivariable
analysis, both PEC alone (hazard ratio [HR] = 2.08; 95% CI 1.97–2.19)
and GH alone (HR = 1.95; 95% CI 1.83–2.07) were risk factors for
subsequent diabetes. Women with GDM alone were at elevated risk of
developing diabetes postpartum (HR = 12.77; 95% CI 12.44–13.10);
however, the co–presence of PEC or GH in addition to GDM further
elevated this risk (HR = 15.75; 95% CI 14.52–17.07, and HR = 18.49; 95%
CI 17.12–19.96, respectively). Data on obesity were not available.
Conclusions
Women
with PEC/GH have a 2-fold increased risk of developing diabetes when
followed up to 16.5 years after pregnancy, even in the absence of GDM.
The presence of PEC/GH in the setting of GDM also raised the risk of
diabetes significantly beyond that seen with GDM alone. A history of
PEC/GH during pregnancy should alert clinicians to the need for
preventative counseling and more vigilant screening for diabetes.
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