The Coexistence of Gestational Hypertension and Diabetes: Influence on Pregnancy Outcome

ABSTRACT

Gestational hypertension (GHTN) and gestational diabetes mellitus (GDM) are both insulin resistance states. Perinatal outcome of GHTN or GDM alone are well established, but their combined effect on pregnancy outcome is underinvestigated. Our objective was to determine if pregnancies complicated by GHTN/GDM have higher rates of morbidity. We identified nulliparous women with singleton pregnancies delivering at 37 to 40 weeks of gestation from 1995 to 2004 from a database. Outcomes of pregnancies complicated by GHTN only, GDM only, or combined GHTN/GDM were compared with controls. Data analysis included the Mann-Whitney U test, the Kruskal-Wallis H test, and analysis of variance. Multivariate analysis was used to adjust for confounders. Of 14,880 patients, there were 11,349 controls, 2604 GHTN, 728 GDM, and 199 GHTN/GDM. After controlling for covariates, GHTN significantly increased cesarean section (C/S) rate (odd ratio [OR], 1.62; confidence interval [CI], 1.47 to 1.78), rates of admittance to the neonatal intensive care unit (NICU), and birth of large for gestational age (LGA) infants. GDM significantly increased C/S (OR, 1.42; CI 1.21 to 1.66), rates of NICU admission (OR, 1.32; CI, 1 to 1.75), birth of LGA (OR, 1.51; CI 1.14 to 1.98), and macrosomic infants (OR, 1.53; CI, 1.12 to 2.08). Rates of LGA infants (OR, 1.85; CI, 1.19 to 2.86) and C/S (OR, 2.03; CI, 1.52 to 2.71) were significantly increased with GHTN/GDM. We concluded that GHTN or GDM is associated with increased rates of adverse outcomes. Their coexistence further increases adverse perinatal outcomes.

KEYWORDS

Gestational hypertension - gestational diabetes - macrosomia

REFERENCES

• 1 Sibai B M. Diagnosis and management of gestational hypertension and preeclampsia.  Obstet Gynecol. 2003;  102 181-192
• 2 Jovanovic L, Pettitt D J. Gestational diabetes mellitus.  JAMA. 2001;  286 2516-2518
• 3 Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study.  Lancet. 2006;  368 1164-1170
• 4 Seoud M A, Nassar A H, Usta I M, Melhem Z, Kazma A, Khalil A M. Impact of advanced maternal age on pregnancy outcome.  Am J Perinatol. 2002;  19 1-7
• 5 Barton J R, O'Brien J M, Bergauer N K, Jacques D L, Sibai B M. Mild gestational hypertension remote from term: progression and outcome.  Am J Obstet Gynecol. 2001;  184 979-983
• 6 Barton J R, Stanziano G J, Sibai B M. Monitored outpatient management of mild gestational hypertension remote from term.  Am J Obstet Gynecol. 1994;  170 765-769
• 7 Langer O, Yogev Y, Most O, Xenakis E M. Gestational diabetes: the consequences of not treating.  Am J Obstet Gynecol. 2005;  192 989-997
• 8 Goldman M, Kitzmiller J L, Abrams B, Cowan R M, Laros Jr R K. Obstetric complications with GDM: effects of maternal weight.  Diabetes. 1991;  40 79-82
• 9 Bauman W A, Maimen M, Langer O. An association between hyperinsulinemia and hypertension during the third trimester of pregnancy.  Am J Obstet Gynecol. 1988;  159 446-450
• 10 Joffe G M, Esterlitz J R, Levine R J for the Calcium for Preeclampsia Prevention Study (CPEP) Study Group et al. The relationship of abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women.  Am J Obstet Gynecol. 1998;  179 1032-1037
• 11 Parretti E, Lapolla A, Dalfrà M et al.. Preeclampsia in lean normotolerant pregnant women can be predicted by simple insulin sensitivity indexes.  Hypertension. 2006;  47 449-453
• 12 Solomon C G, Carroll J S, Okamura K, Graves S W, Seely E W. Higher cholesterol and insulin levels are associated with increased risk for pregnancy-induced hypertension.  Am J Hypertens. 1999;  12 276-282
• 13 Innes K E, Wimsatt J H, McDuffie R. Relative glucose tolerance and subsequent development of hypertension in pregnancy.  Obstet Gynecol. 2001;  97 905-910
• 14 Erez-Weiss I, Erez O, Shoham-Vardi I, Holcberg G, Mazor M. The association between maternal obesity, glucose intolerance and hypertensive disorders in pregnancy in nondiabetic pregnant women.  Hypertens Pregnancy. 2005;  24 125-136
• 15 Pouta A, Hartikainen A, Sovio U et al.. Manifestations of metabolic syndrome after hypertensive pregnancy.  Hypertension. 2004;  43 825-831
• 16 Callaway L K, Lawlor D A, O'Callaghan M, Williams G M, Najman J M, McIntyre D. Diabetes mellitus in the 21 years after a pregnancy that was complicated with hypertension: findings from a prospective cohort study.  Am J Gynecol. 2007;  197 492.e1-492.e7
• 17 Obesity in pregnancy. ACOG Committee Opinion No. 315. American College of Obstetricians and Gynecologists.  Obstet Gynecol. 2005;  106 671-675
• 18 Rosenberg T J, Garbers S, Chavkin W, Chiasson M A. Prepregnancy weight and the risk of adverse pregnancy outcome.  Obstet Gynecol. 2003;  102 1022-1027
• 19 Weiss J L, Malone F D, Emig D et al.. Obesity, obstetric complications and cesarean delivery rate-a population based screening study.  Am J Obstet Gynecol. 2004;  190 1091-1097
• 20 Kabiru W, Raynor D. Obstetric outcomes associated with increase in BMI category during pregnancy.  Am J Obstet Gynecol. 2004;  191 928-932
• 21 Catalano P M. Management of obesity in pregnancy.  Obstet Gynecol. 2007;  109 419-433
• 22 Yang J, Cummings E A, O'Connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies.  Obstet Gynecol. 2006;  108 644-650
• 23 Langer O, Yogev Y, Xenakis E MJ, Brustman L. Overweight and obese in gestational diabetes: the impact on pregnancy outcome.  Am J Obstet Gynecol. 2005;  192 1768-1776
• 24 Chauhan S P, Grobman W A, Gherman R A et al.. Suspicion and treatment of macrosomic infants.  Am J Obstet Gynecol. 2005;  193 332-346
• 25 Langer O, Rodriguez D A, Xenakis E M, McFarland M B, Berkus M D, Arredondo F. Intensified versus conventional management of gestational diabetes.  Am J Obstet Gynecol. 1994;  170 1036-1047
• 26 Cundy T, Slee F, Gamble G, Neale L. Hypertensive disorders of pregnancy in women with type 1 and type 2 diabetes.  Diabet Med. 2002;  19 482-489
• 27 Kvetny J, Pulsen H F. Incidence of gestational hypertension in gestational diabetes.  Arch Gynecol Obstet. 2003;  267 153-157
• 28 Caughey A B. Obesity, weight loss and pregnancy outcomes.  Lancet. 2006;  368 1136-1138

0 Presented at the 15th World Congress of the International Society for the Study of Hypertension in Pregnancy (IHSSP), Lisbon, Portugal, July 3, 2006.