期刊
ACTA DIABETOLOGICA
卷 50, 期 5, 页码 781-787出版社
SPRINGER-VERLAG ITALIA SRL
DOI: 10.1007/s00592-012-0415-0
关键词
Diabetic retinopathy; Hypertensive pregnancy; Pre-eclampsia; Pregnancy-induced hypertension; Severe diabetic retinopathy; Type 1 diabetes
资金
- Folkhalsan Research Foundation
- Helsinki University Central Hospital Research Funds (EVO)
- Wilhelm and Else Stockmann Foundation
- Waldemar von Frenckell Foundation
- Liv och Halsa Foundation
- Finnish Medical Society (Finska Lakaresallskapet)
- Diabetes Research Foundation
- Biomedicum Helsinki Foundation
To investigate whether pre-eclampsia (PE) or pregnancy-induced hypertension (PIH) predicts the development of severe diabetic retinopathy (SDR) in type 1 diabetes. Altogether, 203 women with type 1 diabetes who were followed during pregnancy were re-examined within the Finnish Diabetic Nephropathy Study. After excluding patients with pre-pregnancy hypertension and those who had had laser treatment or whose retinopathy was graded as proliferative at the index pregnancy, 158 were prospectively studied. As a surrogate marker for SDR, retinal laser photocoagulation was used. The time from pregnancy to SDR (N = 21) or follow-up was 16 years (interquartile range, 11-19). HbA(1c) was repeatedly measured both during pregnancy and follow-up. Women with prior PE (26 % vs. 6 %, P = 0.003) or PIH (24 % vs. 6 %, P = 0.008) had more often incident SDR during follow-up compared to those with normotensive pregnancy. The hazard ratios (HR) remained associated with the progression to SDR after adjustment for duration of diabetes and diabetic nephropathy in a Cox regression analysis [PE: 3.5 (95 % CI 1.1-10.9); P = 0.03 and for PIH: 3.2 (1.1-9.8); P = 0.04]. The association between PIH and incident SDR did not change after inclusion of mean HbA(1c), measured during pregnancy (all 3 trimesters) and serial HbA(1c) measurements during follow-up, 3.5 (1.1-11.8; P = 0.03). However, in a similar model, the HR for PE was no more significant 2.0 (0.6-6.8; P = NS). The results suggest that women with type 1 diabetes and a hypertensive pregnancy have an increased risk of severe diabetic retinopathy later in life.
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