Frequency of preeclampsia spectrum disorders by diabetes subgroup

We aim to determine the frequency of preeclampsia (PE) spectrum disorders among subjects with diabetes by subtype: Type 1 diabetes mellitus (T1DM); Type 2 DM (T2DM); gestational diabetes diet controlled (A1GDM); medication controlled GDM (A2GDM); and hyperglycemia in early pregnancy. We hypothesized a higher rate of PE with severe features among those with T1DM and T2DM. This was a retrospective cohort study of gravidas with adjudicated DM and PE diagnoses who delivered between 2010-2021. Hyperglycemia in early pregnancy was defined as a first trimester hemoglobin A1c between 5.7-6.4% or a fasting glucose of 92-125 mg/dL. Rates of gestational hypertension (HTN) and PE with or without severe features were analyzed. Superimposed PE was analyzed separately. Eclampsia and HELLP were included within PE with severe features. Student’s t-test and Chi-square analyses were performed. Logistic regression was performed to control for baseline differences between groups. 1151 subjects with DM were included in the analysis: 97 T1DM, 323 T2DM, 128 A1GDM, 155 A2GDM, and 448 early gestational hyperglycemia. First trimester body mass index was significantly higher in the T2DM and A2GDM groups (P< .001), while chronic HTN was more frequent in the T1DM and T2DM groups (p=.001) (Table 1). There were differences between age, parity, and race among DM subgroups; only race and parity differed by PE outcome. Excluding those with underlying chronic HTN, the rate of PE with and without severe features was highest in T1DM (25.0%, 18.8%) and T2DM (24.2%, 14.1%) (Table 2). T1DM and T2DM remained independent risk factors for PE without severe features (aOR 6.9, 95% CI 1.97-24.0; aOR 3.68, 95% CI 1.21-11.23) after controlling for parity and race. A sub-analysis among subjects with chronic HTN was performed: superimposed PE was most common in T1DM (17/33, 51.5%), T2DM (68/125, 54.4%) and A1GDM (15/29, 51.7%)(p=0.01). The frequency of PE differed between DM subgroups. Those with pregestational DM are most likely to develop PE spectrum disorders and warrant close surveillance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)