medwireNews: Among pregnant women with preexisting diabetes, those with nephropathy or retinopathy may be at increased risk for pregnancy complications, suggest findings from a systematic review and meta-analysis.
Therefore, “[i]t is essential that antenatal care of pregnant women with microvascular disease should involve a multidisciplinary team, including maternal medicine and nephrology,” say Shakila Thangaratinam (University of Birmingham, UK) and colleagues.
The researchers synthesized data from 56 cohort studies including a total of 12,819 pregnant women with type 1 or type 2 diabetes. Among women with available data, there were 92 preeclampsia events in 273 individuals with microvascular disease, compared with 95 events in 1196 women without, translating into a significantly increased risk associated with microvascular disease, at an odds ratio (OR) of 5.9.
Similarly, women with microvascular disease had a significantly elevated risk for preterm birth before 34 weeks (19 events in 73 women vs 17 events in 371 women; OR=8.5) or before 37 weeks (253 in 502 vs 575 in 1882; OR=2.3), as well as for Cesarean birth (210 in 248 vs 341 in 769; OR=5.4). Microvascular disease was also associated with a significantly increased risk for having a small for gestational age (SGA) fetus (21 in 349 vs 11 in 505; OR=2.5).
When the microvascular complications were analyzed separately, women with nephropathy had a significantly increased risk for preeclampsia (OR=10.8), preterm birth before 34 (OR=6.9) or 37 (OR=4.5) weeks, Cesarean delivery (OR=3.0), and pregnancy-induced hypertension (OR=2.7).
And for infant outcomes, maternal diabetic nephropathy was associated with a significantly elevated risk for SGA fetus, at an OR of 16.9, as well as for congenital abnormality, perinatal death, and neonatal unit admission, with ORs ranging from 2.3 to 2.7.
Thangaratinam et al also found that women with diabetic retinopathy had a significantly higher risk for preeclampsia (OR=2.2) and preterm delivery before 37 weeks (OR=1.7) than those without, but there were no significant associations between the presence of retinopathy and any other maternal or infant outcomes.
The team says that a number of factors were significantly associated with risk for onset or worsening of retinopathy, including being nulliparous, smoking, having existing proliferative disease, and longer diabetes duration.
“Women with [these] risk factors […] for worsening eye damage should be referred for closer monitoring during pregnancy, and specialist review where deterioration is noted,” write the study authors in PLOS Medicine.
They recommend that “[f]urther research be carried out to study long-term outcomes beyond pregnancy for women with diabetic eye or kidney complications.”
Thangaratinam and team note that no studies in their meta-analysis reported on pregnancy-related outcomes for women with neuropathy, highlighting the need for further studies.
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