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Risks of Dysglycemia Over the First 4 Years After a Hypertensive Disorder of Pregnancy

  • Chuan Wen
    Affiliations
    Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
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  • Amy Metcalfe
    Affiliations
    Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada

    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada

    Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada

    Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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  • Todd Anderson
    Affiliations
    Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
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  • Ronald J. Sigal
    Affiliations
    Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada

    Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada

    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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  • Jo-Ann Johnson
    Affiliations
    Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
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  • Michael Carson
    Affiliations
    Department of Medicine and Obstetrics & Gynecology, Hackensack Meridian School of Medicine at Seton Hall, Neptune, New Jersey, United States
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  • Kara A. Nerenberg
    Correspondence
    Address for correspondence: Kara A. Nerenberg MD, MSc, Department of Medicine, University of Calgary, HSC 1410, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
    Affiliations
    Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada

    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

    O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada

    Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
    Search for articles by this author

      Abstract

      Background

      Women with the hypertensive disorders of pregnancy (HDP) (preeclampsia [PE] and gestational hypertension [GHTN]) have increased risks of future diabetes. Postpartum glycemic testing offers early identification and treatment of dysglycemia, but evidence-based recommendations for this high-risk population are lacking. The objective of this study was to describe the risks of developing dysglycemia in women with normotensive and hypertensive pregnancies over the first 4 years postpartum.

      Methods

      The Discharge Abstract Database was used to identify women who delivered singleton live-born infants in Calgary, Alberta, Canada, between January 2010 and December 2012 (N=27,300). This was linked with Calgary Laboratory Services (for glycemic tests) and the Pharmaceutical Information Network databases (for antidiabetes medication prescriptions) over the first 4 years postpartum. Logistic regression analyses compared glycemic testing and results were adjusted for maternal age, gestational age, parity and the Pampalon deprivation index.

      Results

      Women with HDP had more glycemic testing (GHTN 67.8% and PE 69.9% vs normotensive 60.9%; p<0.001) and significantly higher results for fasting plasma glucose (GHTN 4.82±0.51 mmol/L and PE 4.84±0.54 mmol/L vs normotensive 4.73±0.49 mmol/L; p<0.001), random plasma glucose (GHTN 5.20±0.96 mmol/L and PE 5.39±1.71 mmol/L vs normotensive 5.00±0.87 mmol/L; p<0.001) and glycated hemoglobin levels (PE 5.62±0.53% vs normotensive 5.49±0.32%; p<0.001). Women with HDP had a higher adjusted odds (95% confidence interval) of developing type 2 diabetes compared with normotensive women (GHTN: 2.26, 1.50 to 13.4; PE: 2.02, 0.91 to 4.46).

      Conclusions

      The high prevalence of early dysglycemia highlights the importance of targeted postpartum glycemic testing in women after HDP. Further research on optimal glycemic testing (specific tests and timing) in these high-risk women is needed.

      Résumé

      Introduction

      Les femmes ayant des troubles hypertensifs de la grossesse (THG) (prééclampsie [PÉ] et hypertension artérielle gravidique [HTAG]) ont des risques accrus de diabète dans le futur. L'analyse de la glycémie en postpartum permet le dépistage et le traitement précoces de la dysglycémie, mais il manque de recommandations fondées sur des données probantes pour cette population exposée à un risque élevé. L'objectif de la présente étude était de décrire les risques de dysglycémie chez les femmes enceintes normotendues et hypertendues au cours des 4 premières années du postpartum.

      Méthodes

      La Base de données sur les congés des patients a été utilisée pour trouver les femmes qui avaient accouché d'un nouveau-né vivant issu d'une grossesse simple à Calgary, en Alberta, au Canada, entre janvier 2010 et décembre 2012 (N = 27 300). Ces données ont été liées aux Calgary Laboratory Services (pour des analyses de la glycémie) et aux bases de données du Pharmaceutical Information Network (pour les ordonnances de médicaments antidiabétiques) au cours des 4 premières années du postpartum. Les analyses de régression logistique ont permis de comparer les analyses de la glycémie et les résultats ajustés selon l’âge de la mère, l’âge gestationnel, la parité et l'indice de défavorisation de Pampalon.

      Résultats

      Les femmes ayant des THG avaient subi plus d'analyses de la glycémie (HTAG 67,8 % et PÉ 69,9 % vs normotendues 60,9 %; p < 0,001) et avaient des résultats significativement plus élevés de la glycémie plasmatique à jeun (HTAG 4,82 ± 0,51 mmol/l et PÉ 4,84 ± 0,54 mmol/l vs normotendues 4,73 ± 0,49 mmol/l; p < 0,001), de la glycémie plasmatique aléatoire (HTAG 5,20 ± 0,96 mmol/l et PÉ 5,39 ± 1,71 mmol/l vs normotendues 5,00 ± 0,87 mmol/l; p < 0,001) et des concentrations de l'hémoglobine glyquée (PÉ 5,62 ± 0,53 % vs normotendues 5,49 ± 0,32 %; p < 0,001). Les femmes ayant des THG montraient des probabilités ajustées plus élevées (intervalle de confiance à 95 %) de diabète de type 2 par rapport aux femmes normotendues (HTAG: 2,26, de 1,50 à 13,4; PÉ: 2,02, de 0,91 à 4,46).

      Conclusions

      La forte prévalence de dysglycémie précoce montre l'importance des analyses ciblées de la glycémie en postpartum chez les femmes qui avaient eu des THG. D'autres recherches sur les analyses de la glycémie optimale (analyses et périodes précises) chez ces femmes exposées à un risque élevé sont nécessaires.

      Keywords

      Mots clés

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