STRATEGIES FOR REDUCING THE FREQUENCY OF PREECLAMPSIA IN PREGNANCIES WITH INSULIN-DEPENDENT DIABETES-MELLITUS

The object of this study was whether improving glycemic control and ma intaining normal glycosylated hemoglobin (HbA(1c)) through pregnancy c an reduce the frequency of preeclampsia. One hundred and twenty-three complete medical records of pregnant insulin-dependent diabetics (IDDM ) managed at Yale-New Haven Hospital from 1983 to 1993 were reviewed. Serial HbA(1c) measurements and the occurrence of preeclampsia were re corded. Based on the change of HbA, values through the pregnancy, glyc emic control was categorized into four groups: group 1, high to normal ; group 2, high to high; group 3, normal to normal; group 4, normal to high. The association between HbA(1c) change and the incidence of pre eclampsia was analyzed by chi-square test and Fisher's exact test. Amo ng 123 IDDM pregnancies, 40 (32.5%) developed preeclampsia. High HbA(1 c) levels at any time in IDDM pregnancies were associated with an incr eased incidence of preeclampsia (group 1 or 2 or 4 versus group 3). Re ducing HbA(1c) by improving glycemic control both before and during pr egnancy resulted in a significantly lower incidence of pre-eclampsia ( group 3 versus groups 1+2+4, p <0.05). The best strategy for reducing the frequency of preeclampsia in IDDM pregnancies is by improving glyc emic control before pregnancy.