OP4 Clinical implications of a history of preeclampsia in type two diabetes mellitus

Introduction Preeclampsia is a major cause of maternal morbidity and mortality. The dangers are not limited to gestational complications; a single preeclampsia episode predisposes to many serious future health conditions. Little is known about how preeclampsia impacts the onset and clinical course of type 2 diabetes (T2D). Methods The Scottish Care Information for Diabetes (SCI-Diabetes) data for all individuals with diabetes managed in NHS Tayside and Fife health boards was linked with national Scottish Morbidity Records (SMR02) for maternity inpatient and day cases. T-tests compared BMI, HDL cholesterol, systolic blood pressure and HbA1c measures at T2D diagnosis between women with pregnancies affected or unaffected by preeclampsia. Using linear regression we determined the impact of a preeclampsia history on age at T2D diagnosis independent of these measures. Cox's regression models assessed how a history of preeclampsia influenced risk of future complications, adjusted for age and HbA1c at T2D diagnosis. Results 6055 women diagnosed with T2D also had pregnancy information in the SMR02 data. 726 (12%) had a history of preeclampsia in at least one pregnancy, and 5329 (88%) had no such history. Compared to women with preeclampsia free pregnancies those with preeclampsia had higher BMI (38.3 kg/m² vs 35.7 kg/m², p<0.0001), higher systolic blood pressure (139 mmHg vs 135 mmHg, p<0.0001), lower HDL (1.18 mmol/L vs 1.21 mmol/L, p=0.002) and were diagnosed with T2D 3.26 years earlier (p<0.0001). Preeclampsia was also associated with increased risks for diabetic retinopathy (HR 1.22 95%CI 1.07–1.38, p=0.003) and chronic kidney disease (HR 1.35 95%CI 1.06–1.71, p=0.016), in particular for diabetic proteinuric kidney disease (HR 2.45 95%CI 1.03–5.81, p<0.0001). Conclusions A history of preeclampsia during pregnancy is associated with earlier onset T2D, a more severe clinical phenotype and increased T2D complications risk. This indicates a need for improved long term clinical assessment and management in this patient group.