The Impact of Pregnancy and Parity on Type 1 Diabetes Complications

Author(s): Monika Zurawska-Klis*, Katarzyna Cypryk.

Journal Name: Current Diabetes Reviews

Volume 15 , Issue 6 , 2019

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Abstract:

Background: The potential influence of pregnancy and parity on the risk of chronic diabetic complications is a matter of great concern and constant discussion. This aspect seems relevant and should be the subject of thorough discussion with the woman planning childbirth.

Introduction: Current data concerning the impact of pregnancy and parity covers primarily retinopathy and nephropathy, while the aspects of neuropathy and macrovascular complications are unsatisfactorily documented. Majority of studies focus on single complication only, while the number of papers assessing this problem in a complex setting is limited. The available body of evidence concerns mainly the short-term impact of pregnancy on diabetic chronic complications while the data concerning the longer perspective are scarce. Moreover, the results found in the available literature are conflicting. The aim of the study was to summarize all available data concerning the longer impact of parity on the chronic complications in the women with type 1 diabetes.

Methods: PubMed database has been searched between October 2013 and September 2018 and all relevant papers were selected. This review summarizes data on the impact of pregnancy and parity on chronic complications in type 1 diabetic women.

Results: Current data assessing this matter in a complex way are limited, and the available results are controversial. It seems however that pregnancy itself may rather influence pre-existing diabetic complication than affect risk of its development. Additionally, evidence suggests that any deleterious changes appearing during pregnancy are transient and tend to remit after delivery.

Conclusion: It seems that neither pregnancy nor parity affects the risk of diabetic chronic complications in the longer perspective.

Keywords: Parity, type 1 diabetes, chronic complications, pregnancy, diabetic, retinopathy.

[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, 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 Ophthalmol 1988; 32: 219-38.
[5]
Rosenn B, Miodovnik M, Kranias G, 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: 1084-91.
[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, 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: 165-9.
[15]
Cypryk K, Grycewicz J, Swierzewska P, Kosinski M, Lewinski A, Zurawska-Klis M. Parity does not affect diabetes complications in women with type 1 diabetes. Ann Agric Environ Med 2018; 25(1): 114-9.
[16]
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.
[17]
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.
[18]
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.
[19]
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.
[20]
Rossing K, Jacobsen P, Hommel E, et al. Pregnancy and progression of diabetic nephropathy. Diabetologia 2002; 45(1): 36-41.
[21]
Toda J, Kato S, Sanaka M, Kitano S. The effect of pregnancy on the progression of diabetic retinopathy. Jpn J Ophthalmol 2016; 60(6): 454-8.
[22]
Morrison JL, Hodgson LA, Lim LL, Al-Qureshi S. Diabetic retinopathy in pregnancy: A review. Clin Exp Ophthalmol 2016; 44(4): 321-34.
[23]
Mills JL, Knopp RH, Simpson JL, et al. Lack of relation of increased malformation rates in infants of diabetic mothers to glycemic control during organogenesis. N Engl J Med 1988; 318(11): 671-6.
[24]
Jensen DM, Damm P, Moelsted-Pedersen L, et al. Outcomes in type 1 diabetic pregnancies: A nationwide, population-based study. Diabetes Care 2004; 27(12): 2819-23.
[25]
Wahabi HA, Alzeidan RA, Bawazeer GA, Alansari LA, Esmaeil SA. Preconception care for diabetic women for improving maternal and fetal outcomes: A systematic review and meta-analysis. BMC Pregnancy Childbirth 2010; 10: 63.
[http://dx.doi.org/10.1186/1471-2393-10-63]
[26]
Gomes MB, Negrato CA, Almeida A, de Leon AP. Does parity worsen diabetes-related chronic complications in women with type 1 diabetes? World J Diabetes 2016; 7(12): 252-9.
[27]
Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: Nationwide prospective study in the Netherlands. BMJ 2004; 328(7445): 915.
[http://dx.doi.org/10.1136/bmj.38043.583160.EE]
[28]
Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care 2009; 32(11): 2005-9.
[29]
Lovestam-Adrian M, Agardh CD, Aberg A, Agardh E. Pre-eclampsia is a potent risk factor for deterioration of retinopathy during pregnancy in type I diabetic patients. Diabet Med 1997; 14: 1059-65.
[30]
Kaaja R, Loukovaara S. Progression of retinopathy in type 1 diabetic women during pregnancy. Curr Diabetes Rev 2007; 3(2): 85-93. [Review].
[31]
Loukovaara S, Immonen I, Koistinen R, Hiilesmaa V, Kaaja R. Inflammatory markers and retinopathy in pregnancies complicated with type I diabetes. Eye (Lond) 2005; 19(4): 422-30.
[32]
Klein BE, Moss SE, Klein R. Effect of pregnancy on progression of diabetic retinopathy. Diabetes Care 1990; 13(1): 34-40.
[33]
Sheth BP. Does pregnancy accelerate the rate of progression of diabetic retinopathy?: An update. Curr Diab Rep 2008; 8(4): 270-3.
[34]
Klein BE, Klein R. Gravidity and diabetic retinopathy. Am J Epidemiol 1984; 119: 564-9.
[35]
Arun CS, Taylor R. Influence of pregnancy on long-term progression of retinopathy in patients with type 1 diabetes. Diabetologia 2008; 51(6): 1041-5.
[36]
Bhatnagar A, Ghauri A-J, Hope-Ross M, Lip PL. Diabetic retinopathy in pregnancy. Curr Diabetes Rev 2009; 5(3): 151-6.
[37]
Diamond MP, Reece EA, Caprio S. Impairment of counter regulatory hormone responses to hypoglycemia in pregnant women with insulin dependent diabetes mellitus. Am J Obstet Gynecol 1992; 166: 70-7.


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Article Details

VOLUME: 15
ISSUE: 6
Year: 2019
Page: [429 - 434]
Pages: 6
DOI: 10.2174/1573399815666190115143538
Price: $65

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