Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus

OBJECTIVES: This study was undertaken to determine the frequencies of preec lampsia and adverse neonatal outcomes among women with pregestational diabe tes. STUDY DESIGN: This was a prospective observation of pregnancy outcomes amon g 462 women with pregestational diabetes mellitus (White classes B-F) and s ingleton pregnancies who were enrolled in a multicenter trial to compare lo w-dose aspirin with placebo for preeclampsia prevention. The main outcome m easures were preeclampsia and neonatal outcomes. RESULTS: Among 462 women with pregestational diabetes, 92 (20%) had preecla mpsia. Preeclampsia frequency rose significantly with increasing severity o f diabetes according to White classification (class B, 11%; class C, 22%; c lass D, 21%; class R plus class F, 36%; P < .0001). Preeclampsia was also m ore common among women who had proteinuria at baseline (28% vs 18%; odds ra tio, 1.75; 95% confidence interval, 1.02-3.01). Frequency of preterm delive ry at <35 weeks' gestation rose greatly with increasing severity of diabete s (P = .0002). Women with proteinuria at baseline were significantly more l ikely to be delivered at <35 weeks' gestation (29% vs 13%; odds ratio, 2.6; 95% confidence interval, 1.5-4.6) and to have small-for-gestational-age in fants (14% vs 3%; odds ratio, 5.4; 95% confidence interval, 2.7-17.7), and they were less likely to have large-for-gestational-age infants (14% vs 40% , odds ratio, 0.2; 95% confidence interval, 0.1-0.5). CONCLUSION: Among women with pregestational diabetes mellitus, the frequenc y of preeclampsia rose with increasing severity of diabetes. Proteinuria ea rly in pregnancy was associated with marked increases in adverse neonatal o utcomes independent of preeclampsia development.