Gestational diabetes and preeclampsia – Similar risk factor profiles?

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Abstract

Background

Gestational diabetes and preeclampsia are leading causes of complications during pregnancy.

Aims

The aims of this study were to quantify the probability that both diseases occur together, to evaluate commonality of risk factor profiles, and to clarify the connection between gestational diabetes and preeclampsia in combination with the maternal body mass index.

Study design

We analysed data of the German Perinatal Quality Registry 2006, an annual full inventory of all hospital births in Germany.

Subjects

The Registry contains the complete national birth cohort of 668,085 newborn infants and 647,392 mothers from 896 German obstetric clinics.

Outcome measures

Each case of gestational diabetes or preeclampsia that was identified during pregnancy by a gynaecologist or in the hospital was fully registered.

Results

The prevalence of GDM was 2.32% and that of PE was 2.31%, resulting in 0.09% of all pregnant women being diagnosed with both diseases. GDM was found to be an independent risk factor for PE. Increased maternal age, nulliparity, and multiple gestation pregnancies could be identified as common risk factors for both diseases, while increased pre-pregnancy body mass index was found to be the most important predictor for both diseases.

Conclusions

As PE and GDM share similar risk factors, identification of high-risk groups by simultaneous screening methods seems to be reasonable for prevention of complications. Further studies will be needed to investigate possible pathophysiological pathways increased body mass index has on the induction of both diseases.

Introduction

Gestational diabetes (GDM) and preeclampsia (PE) are leading causes of complications during pregnancy with serious negative effects on the health of both the mother and her unborn child [1], [2], [3]. In recent years the pathophysiologies of both illnesses have been shown to be associated with one another [3], [4], [5], [6]. It seems that gestational diabetes and preeclampsia have several mechanisms in common: For example, altered carbohydrate metabolism as a result of gestational diabetes causes vascular changes such as arteriosclerosis and a glomerular filtration dysfunction, which can result in a predisposition for preeclampsia. Due to this, some authors have recently discussed gestational diabetes as a risk factor of preeclampsia and preeclampsia as a possible consequence of gestational diabetes [5]. This is supported by the fact that a prospective random study was able to prove that the treatment of gestational diabetes reduced the rate of preeclampsia by 30% [7]. According these results, the treatment of gestational diabetes would be an effective measure to prevent preeclampsia. Other authors cite dysfunctions such as increased insulin resistance as the cause of both illnesses [3], [4], [8], [9]. Several authors therefore reach the conclusion that the state of research inadequate and ambiguous [4], [8], [9], [10].

It has so far been difficult to provide support for these explanations in the form of epidemiological data. The main reason for this is the prevalence rate of both conditions of less than 10%. The rate of the joint occurrence of both illnesses in the population is therefore in the order of parts per thousand, meaning that large, population based studies with sufficient power are needed to delineate the relation between gestational diabetes and preeclampsia and the influence of possible confounders [10]. A point of criticism regarding the data previously available is also that many studies do not account for common risk factors like obesity [9]. With the present work we intend:

1) to quantify the probability that gestational diabetes and preeclampsia occur together during pregnancy, 2) to evaluate commonality of risk factor profiles for both diseases, and 3) to clarify the connection between gestational diabetes and preeclampsia in combination with the maternal body mass index.

Section snippets

Database: German Perinatal Quality Registry

The German Perinatal Quality Register is an annual full inventory of all hospital births in Germany [11]. The Registry is part of a standardized national medical and nursing quality assurance program for German hospitals. The program was set up in 2001 with the involvement of the governing bodies of the Statutory Health Insurance System, the Association of German Private Health Insurance companies, the German Hospital Association, the German Medical Board and Long-Term Nursing Care Insurance

Prevalence of gestational diabetes and preeclampsia

In Germany, the prevalence of gestational diabetes was 2.32% (14,990/647,385) and that of preeclampsia was 2.31% (14,934/647,385) among all pregnant women in 2006. The prevalence of having both illnesses was 0.09% of all pregnant women (Fig. 1). This represents 4.1% of all cases of gestational diabetes and preeclampsia cases. Women with preconceptional diabetes mellitus were therefore excluded from the analyses.

Risk groups

Risk groups for the development of gestational diabetes were non German women as

Statement of principal findings

The results demonstrate that the overall prevalence of gestational diabetes and preeclampsia in Germany is low (2.32% and 2.31%, respectively). Only 0.09% of all pregnant women developed both illnesses during one pregnancy. Both diagnoses have a similar profile of risk factors: High risk groups for the development of each disease is higher for older and obese women with lower social status, no prior as well as multiple births. Heavy smoking appears to be negatively correlated with both

Conflict of interest statement

A small part of this study was supported by a grant from Roche Diagnostics GmbH, Mannheim, Germany. The authors report no conflict of interest. The authors alone were responsible for the content and writing of the paper.

Acknowledgements

This publication was based on a research visit of the first (Sv.S.) and fourth (B.H.) author to the German Federal Agency for Quality Assurance gGmbH (Düsseldorf, Germany). We would like to thank Burkhard Fischer for assessing the data, for valuable technical and method information and for discussing and interpreting the results. Finally, we wish to thank Christina Huy, Dipl.-Inform. Med., M.Sc. (MIPH) for her helpful comments and support.

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