Clinical implications of a history of pre-eclampsia in women with type two diabetes mellitus.

AIMS: The consequences of pre-eclampsia (PE) are not limited to pregnancy; a single episode predisposes mothers to serious future health outcomes. Little is known about how PE impacts the course of type 2 diabetes (T2D) and associated microvascular diseases.

METHODS

The Scottish Care Information for Diabetes data for individuals with diabetes in NHS Tayside and Fife was linked with Scottish maternity morbidity records. A nested case-control study compared BMI, HDL cholesterol, systolic blood pressure(SBP) and HbA1c measures at T2D diagnosis between women with prior pregnancies from 1921 to 2022 affected or unaffected by PE using linear regression and adjusted for the other aforementioned variables. Cox regression models assessed how a PE history influenced the risk of future microvascular complications following T2D diagnosis.

RESULTS

In total, 6055 women were eligible: 726 (12%) had a PE-pregnancy and 5329 (88%) had only PE-free pregnancies, with ~20 years between pregnancy and T2D diagnosis. At T2D diagnosis, women with a PE history had higher BMI (38.3 kg/m2 vs. 35.7 kg/m2, p < 0.001), higher SBP (139 mmHg vs. 135 mmHg, p < 0.001), lower HDL cholesterol (1.18 mmol/L vs. 1.21 mmol/L, p = 0.002) and were diagnosed 3.2 years earlier (p < 0.001). A PE history was associated with increased microvascular disease risk (HR 1.26 95% CI 1.12-1.42, p < 0.001): diabetic retinopathy (HR 1.22 95% CI 1.07-1.38, p = 0.003); chronic kidney disease (HR 1.35 95% CI 1.06-1.71, p = 0.016); diabetic proteinuric kidney disease (HR 2.45 95% CI 1.03-5.81, p < 0.001). Women with a PE history were ~5 years younger when they developed cardiovascular disease (55.7 years vs. 60.6 years, p < 0.001) and all-cause death (60.1 years vs. 65.6 years, p < 0.0001).

CONCLUSIONS

At T2D diagnosis, women with a PE history are younger, with more severe clinical presentations and increased risk of developing T2D microvascular complications. This highlights the crucial need for changes to the long-term care of this high-risk group, with aggressive risk-factor management and continued clinical assessment.