Microalbuminuria, Preeclampsia, and Preterm Delivery in Pregnant Women With Type 1 Diabetes

Microalbuminuria, Preeclampsia, and Preterm Delivery in Pregnant Women With Type 1 Diabetes Results from a nationwide Danish study Dorte M. Jensen , PHD 1 , Peter Damm , DMSC 2 , Per Ovesen , DMSC 3 , Lars Mølsted-Pedersen , DMSC 4 , Henning Beck-Nielsen , DMSC 1 , Jes G. Westergaard , DMSC 5 , Margrethe Moeller , MD 6 and Elisabeth R. Mathiesen , DMSC 2 1 Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark; 2 Departments of Endocrinology and Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 3 Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark; 4 Department of Obstetrics and Gynecology, Copenhagen County Hospital, University of Copenhagen, Copenhagen, Denmark; 5 Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark; 6 Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark. Corresponding author: Dorte M. Jensen, dortemj{at}dadlnet.dk . Abstract OBJECTIVE To study the association between microalbuminuria and development of preeclampsia and preterm delivery in pregnant women with type 1 diabetes. RESEARCH DESIGN AND METHODS This was a population-based prospective study in 846 normoalbuminuric or microalbuminuric women with type 1 diabetes without antihypertensive treatment in early pregnancy. Data were collected prospectively by one to three caregivers in each center and reported to a central registry. RESULTS The prevalence of microalbuminuria in the first trimester was 10%, median diabetes duration was 11 years, and third-trimester A1C was 6.6%. The frequencies of preeclampsia and preterm delivery before 34 weeks in the microalbuminuric group were 40 and 13%, both significantly higher than those in the normoalbuminuric group (12 and 6%, respectively, P < 0.001). After adjustments for possible confounders, significant predictors for development of preeclampsia were microalbuminuria (odds ratio 4.0 [95% CI]), nulliparity (3.1 [1.9–5.1]), and third-trimester A1C (1.3 [1.1–1.5] per 1% increase). Delivery before 34 weeks was associated with early microalbuminuria in univariate analyses, but in multivariate analyses A1C was the only significant predictor of this outcome. Preeclampsia was associated with a threefold higher risk of delivery before 34 weeks. CONCLUSIONS The presence of microalbuminuria in early pregnancy is associated with a fourfold inc