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Pregnant women with microalbuminuria have high prevalence of preterm delivery

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WESTPORT, CT (Reuters Health) – The prevalence of preterm delivery is significantly increased among type 1 diabetic women with microalbuminuria, mainly because of preeclampsia, according to the results of a recent study.

In order to examine the influence of microalbuminuria on pregnancy outcomes, Dr. Elisabeth R. Mathiesen, of the National University Hospital in Copenhagen, and colleagues prospectively studied 240 type 1 diabetic women who were admitted to obstetric care before 17 weeks of gestation.

The researchers explain that the women were "categorized according to their urinary albumin excretion (normal urinary albumin excretion, less than 30 mg/24 h; microalbuminuria, 30 to 300 mg/24 h; or diabetic nephropathy, more than 300 mg/24 h) before pregnancy or in the first trimester."

Overall, 203 women (85%) had normal urinary albumin excretion, 26 (11%) had microalbuminuria, and 11 (5%) had diabetic nephropathy, according to the research team's report in the October issue of Diabetes Care. "Mean HbA1c at 2 to 6 weeks [of gestation] was 7.5%, 8.1%, and 8.8% (p < 0.001), respectively," the team notes.

Thirty-five percent of women with normal urinary albumin excretion delivered preterm, compared with 62% of women with microalbuminuria and 91% of women with diabetic nephropathy (p < 0.001). A total of 2%, 4% and 45% (p < 0.001), respectively, had small-for-gestational-age infants.

Preeclampsia developed in 6%, 42%, and 64% of the women, respectively. In multivariate analysis, "category of urinary albumin excretion (p < 0.01) and HbA1c at 2 to 6 weeks (p < 0.05) were independently associated with preterm delivery," Dr. Mathiesen and colleagues explain.

They conclude that "classification according to urinary albumin excretion and metabolic control around the time of conception are superior to the White classification in predicting preterm delivery in women with type 1 diabetes."

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