Controlling Blood Pressure In Diabetics Boosts Term Births

Lead investigator Dr. Lene Ringholm Nielsen stated that,  "Diabetic women with kidney involvement have an increased risk of complications in pregnancy leading to preterm delivery."  "This paper describes how intensive antihypertensive treatment in pregnant diabetic women reduces the risk of complications in pregnancy."

Dr. Nielsen and colleagues studied 117 pregnant women with diabetes. Antihypertensive therapy was used where required to maintain blood pressure below 135/85 mmHg and urinary albumin excretion below 300 mg/24 hours.

Treatment was given to 14 of 100 women with normal urine albumin excretion, 5 of 10 with microalbuminuria, and all 7 women with diabetic nephropathy. Mean systolic blood pressures in these groups was 120, 122, and 135 mmHg, respectively. There were no differences in mean diastolic pressure or in hemoglobin A1C level among groups.

There were three cases of preeclampsia, all in women with diabetic nephropathy. The incidence of preterm delivery was 20% in women with normoalbuminuria and microalbuminuria and 71% in women with diabetic nephropathy. In this group, the median gestational age was 258 days.

Mean birth weights were similar in the normoalbuminuria (3540 g) and microalbuminuria (3430 g) groups but lower among women with diabetic nephropathy (2765 g).

However, say the investigators, "Compared with previous studies using (a) less stringent antihypertensive therapeutic strategy and less strict metabolic control," both gestational age and birth weight were greater in this study.

Thus, concluded Dr. Nielsen, the result "suggests that early control of hypertensive problems in diabetic pregnancy leads to a higher number of infants born to term."

Diabetes Care 2009;32:38-44.