Hypertensive disorders of pregnancy and gestational diabetes

Hypertensive disorders of pregnancy (HDP): pregnancy-induced hypertension (PIH) and preeclampsia are more likely to occur in pregestational diabetics (PGD).The question of wether HDP occur more frequently in gestational diabetics (GD) or certain subsets of gestational diabetics remains unclear. Recent studies have suggested that the incidence of PIH and preeclampsia is higher among GD whose diabetes was diagnosed early in the pregnancy (less than 24 weeks). the present case-control study examines wether there is an increased incidence of HDP among GD after controlling for various risk factors, and if it is possible to identify subgroups at greater risk of developing HDP. We also analysed the incidence of fetal morbidity and mortality in GD + HDP compared to control patients. Hospital charts were retrospectively analysed for all of the prenatal patients followed in Maternidade Daniel de Matos who were diagnosed with GD and delivered between January 1st 1998 and December 31st 2000. Diagnosis of GD was based on a glucose screening test performed at the first prenatal visit. GD were than matched with a control group selected from a computer database of all clinic patients delivered in the same time period. GD who develloped HDP were compared to GD without HDP on the basis of age, body mass, parity, timing of gestational Diabetes diagnosis and perinatal morbidity/mortality. The studied groups were compared by means of chi-square test for independence when the data were categorical and by t student test when the data were ordinal. A p value < 0,05 was considered statistically significant. 437 of all patients followed during the refered period developed gestational Diabetes. The incidence of HDP in this group was not significantly higher than that of the control group (5,5% vs 7,2% p=0,1). Regarding GD, the GD+HDP were older (medium age 33,3 vs 31,6 years), had higher BMI at the beginning of pregnancy ( 30 vs 22), more frequently multiparous (17% vs 4%) and the Diabetes was diagnosed earlier in the pregnancy (21% vs 11%) than the GD without HDP, all statistically significant. The newborns of the GD+HDP had less weight (2891 vs 3277 g), an inferior first minute apgar index (apgar<7 20% vs 6,5%) and a higher mortality rate (4% vs 0,2%) all statistically significant as well. Although the incidence of HDP among GD is not significantly different from that of the control group, HDP affects mainly GD older, with higher BMI, multiparous and with Diabetes diagnosed early in the pregnancy. The coexistence of GD and HDP significantly aggravates the fetal prognostic