Online first

Parity does not affect diabetes complications in women with type 1 diabetes

Department of Diabetology and Metabolic Diseases, Medical University of Lodz, Poland
Regional Centre of Occupational Medicine, Prevention and Treatment Centre in Lodz, Poland
Outpatient Department of Diabetology in the Polish Mother’s Memorial Hospital/Research Institute in Lodz, Poland
Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Poland
The problem concerning the impact of pregnancy on diabetic complications is a matter for discussion as there is some evidence suggesting that pregnancy may trigger development or progression of diabetic chronic complications. However, currently available data concerning this issue is still controversial.

The aim of the study was to evaluate the impact of obstetric history on the development of chronic microangiopatic and macroangiopatic complications in type 1 diabetic women.

Material and Methods:
The retrospective study comprised 226 white Caucasian type 1 diabetic women, including 190 parous and 36 nulliparous women. Anthropometric data, information concerning the course of the disease, including metabolic control and chronic complications, together with obstetric history, were registered.

Parous women were older (p<0.001), but did not differ significantly regarding metabolic control in the course of the disease (p>0.05) and diabetes duration (p>0.05) from nulliparous subjects. There were no significant differences in the incidence (p>0.05) nor onset (p>0.05) of chronic diabetes complications between the groups. The number of deliveries did not correlate with either the incidence nor the onset of chronic complications. Longer DM duration at the moment of first delivery was related to the higher incidence of retinopathy (p<0.01), nephropathy (p<0.05) and neuropathy (p<0.001).

The incidence of chronic diabetic complications does not differ between parous women and the subjects that were never pregnant, and is not related to the number of pregnancies.

Monika Zurawska-Klis   
Department of Diabetology and Metabolic Diseases, Medical University of Lodz, Poland
1. Loukovaara S, Immonen I, Teramo KA, Kaaja R. Progression of retinopathy during pregnancy in type 1 diabetic women treated with insulin lispro. Diabetes Care 2003; 26(4): 1193–8.
2. Wender-Ozegowska E, Zawiejska A, Pietryga M, Zozulińska D, Wierusz-Wysocka B, Chmaj K et al. Effect of pregnancy on diabetic vascular complications. Ginekol Pol. 2004; 75(5): 342–51.
3. Kaaja R. Vascular complications in diabetic pregnancy. Thromb Res. 2011; 127 Suppl 3: S53–5.
4. Sunness JS. The pregnant woman’s eye. Surv Ophtalmol 1988; 32: 219–238.
5. Rosenn B, Miodovnik M, Kranias G, Khoury J, Combs CA, Mimouni F et al. Progression of diabetic retinopathy in pregnancy. Am J Obstet Gynecol. 1992; 166: 1214–8.
6. The Diabetes Control and Complications Trial Research Group. Effect of pregnancy on microvascular complications in the diabetes control and complications trial. Diabetes Care 2000; 23: 1084–1091.
7. Chang S, Fuhrmann M, Jovanovich L. The diabetes in early pregnancy study group (DIEP). Pregnancy, retinopathy normoglycemia. A preliminary analysis. Diabetes 1985; 35: 3A.
8. Temple RC, Aldridge VA, Sampson MJ, Greenwood RH, Heyburn PJ, Glenn A. Impact of pregnancy on the progression of diabetic retinopathy in Type 1 diabetes. Diabet Med. 2001; 18(7): 573–7.
9. Moloney JB, Drury MI. The effect of pregnancy on the natural course of diabetic retinopathy. Am J Ophthalmol. 1982; 93(6): 745–56.
10. Dibble CM, Kochenour NK, Worley RJ, Tyler FH, Swartz M. Effect of pregnancy on diabetic retinopathy. Obstet Gynecol. 1982; 59(6): 699–704.
11. Hemachandra A, Ellis D, Lloyd CE, Orchard TJ. The influence of pregnancy on IDDM complications. Diabetes Care 1995; 18(7): 950–4.
12. Proniewska-Skretek E, Zalewska R, Kraśnicki P, Zarzycka B, Zarzycki W, Mariak Z et al. The influence of pregnancy on progression of diabetic retinopathy. Klin Oczna 2007; 109(7–9): 308–11.
13. Rasmussen KL, Laugesen CS, Ringholm L, Vestgaard M, Damm P, Mathiesen ER. Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes. Diabetologia 2010; 53(6): 1076–83.
14. Kaaja R, Sjoberg L, Hellsted T, Immonen I, Sane T, Teramo K. Long-term effects of pregnancy on diabetic complications. Diabet Med. 1996; 13: 165–169.
15. Jovanovic R, Jovanovic L. Obstetric management when normoglycemia is maintained in diabetic pregnant women with vascular compromise. Am J Obstet Gynecol. 1984; 149: 617–23.
16. Gordon M, Landon MB, Samuels P, Hissrich S, Gabbe SG. Perinatal outcome and long-term followup associated with modern management of diabetic nephropathy (Class F) Obstet Gynecol. 1996; 87: 401–9.
17. Young EC, Pires ML, Marques LP, de Oliveira JE, Zajdenverg L. Effects of pregnancy on the onset and progression of diabetic nephropathy and of diabetic nephropathy on pregnancy outcomes. Diabetes Metab Syndr. 2011; 5(3): 137–42.
18. Miodovnik M, Rosenn BM, Khoury JC, Grigsby JL, Siddiqi TA. Does pregnancy increase the risk for development and progression of diabetic nephropathy? Am J Obstet Gynecol. 1996; 174(4): 1180–9; discussion 1189–91.
19. Rossing K, Jacobsen P, Hommel E, Mathiesen E, Svenningsen A, Rossing P et al. Pregnancy and progression of diabetic nephropathy. Diabetologia 2002; 45(1): 36–41.