Endocrine Abstracts

Introduction: High blood pressure during pregnancy is associated with various maternal and fetal complications. This risk further complicates the pregnancy of diabetic women.

Patients and Methods: We carried out a longitudinal retrospective study including one hundred pregnant women with type 1 and type2 diabetes, recruited from the patients monitored at the national nutrition institute during the period from January to December 2016.

Aim of the study: Study the epidemiological characteristics of a complicated pregnancy of diabetes and hypertension in a Tunisian center, and describe the maternal and fetal outcome of these risky pregnancies.

Results: The average age of our patients was 32.87 ± 5.3 years, the average pre-gestational BMI was 28.2 ± 6.48 kg/m², 63.6% of the patients were overweight. The majority (70%) of patients had unbalanced pre-conception diabetes (HbA1c > 7%). Twelve percent of the patients had a history of high blood pressure. During pregnancy, 17.6% of women were on anti hypertensive therapy (calcium antagonists: 12.4%, beta blocker: 3.1%, central antihypertensive: 2.1%). Only 2.1% of patients presented with pre-eclampsia. For the glycemic parameters, a significant improvement in HbA1c was observed in the 2nd trimester, which was maintained during the 3rd trimester. Patients had reduced their HbA1c in the 2nd trimester by 1.58% compared to pre-conceptual HbA1c (P < 10^–3). The outcome of the pregnancy was favorable with full-term delivery in 72% of the cases. Premature delivery took place in 15% of cases, Therapeutic termination of pregnancy in 1% of cases, early spontaneous abortion in 8% of cases, late abortion in 1% of cases and stillbirth in 3% of cases. The majority (93.3%) of our patients delivered by cesarean. The main causes of cesarean delivery were foetal distress (29.6%), macrosomia (23%) and history of a scar uterus (18.5%). Only 2.4% of caesareans were motivated by pre-eclampsia. The average birth weight was 3577.2 ± 0.72 kg. Macrosomia was observed in 24% of the cases. Five newborns (5.7%) presented neonatal malformations at birth: three cardiac, one urological and one polymalformative syndrome. We found five cases of early neonatal death (5.7%).

Conclusion: Diabetic pregnancy complicated by hypertension is associated with an increased risk of maternal and foetal complications. Pre-conception management and action on modifiable factors could significantly improve the prognosis.