Prediction and prevention of preeclampsia in women with preexisting diabetes: the role of home blood pressure, physical activity, and aspirin

Abstract

Women with type 1 or type 2 (preexisting) diabetes are four times more likely to develop preeclampsia compared with women without diabetes. Preeclampsia affects 9%-20% of pregnant women with type 1 diabetes and 7%-14% of pregnant women with type 2 diabetes. The aim of this narrative review is to investigate the role of blood pressure (BP) monitoring, physical activity, and prophylactic aspirin to reduce the prevalence of preeclampsia and to improve pregnancy outcome in women with preexisting diabetes. Home BP and office BP in early pregnancy are positively associated with development of preeclampsia, and home BP and office BP are comparable for the prediction of preeclampsia in women with preexisting diabetes. However, home BP is lower than office BP, and the difference is greater with increasing office BP. Daily physical activity is recommended during pregnancy, and limiting sedentary behavior may be beneficial to prevent preeclampsia. White coat hypertension in early pregnancy is not a clinically benign condition but is associated with an elevated risk of developing preeclampsia. This renders the current strategy of leaving white coat hypertension untreated debatable. A beneficial preventive effect of initiating low-dose aspirin (150 mg/day) for all in early pregnancy has not been demonstrated in women with preexisting diabetes.

Keywords: aspirin; home blood pressure; hypertension; physical activity; preeclampsia; preexisting diabetes; pregnancy; sedentary behavior.

Figure 1

Scatterplots of the difference in home blood pressure and office blood pressure in relation to the office blood pressure in early pregnancy of 404 women with preexisting diabetes. With increasing office blood pressure, the difference between home blood pressure and office blood pressure is greater. (A) In women with a systolic office blood pressure equal to or above treatment target of 135 mmHg in early pregnancy, systolic home blood pressure is 19 mmHg lower than office blood pressure. (B) In women with office diastolic blood pressure equal to or above treatment target of 85 mmHg in early pregnancy, diastolic home blood pressure is 13 mmHg lower than office blood pressure. Do NC, Home Blood Pressure for the Prediction of Preeclampsia in Women With Preexisting Diabetes, Journal of Clinical Endocrinology & Metabolism, 2022, 18 August 107, e3670–e3678 by permission of Oxford University Press.

Figure 2

Receiver operating characteristic curves and area under the curves showing that home blood pressure, office blood pressure, and mean arterial pressure are comparable in the prediction of preeclampsia in women with preexisting diabetes. BP, blood pressure; MAP, mean arterial pressure. Do NC, Home Blood Pressure for the Prediction of Preeclampsia in Women With Preexisting Diabetes, Journal of Clinical Endocrinology & Metabolism, 2022, 18 August 107, e3670–e3678 by permission of Oxford University Press.

Figure 3

Home blood pressure and office blood pressure values in early pregnancy in 404 pregnant women with preexisting diabetes. Both home blood pressure and office blood pressure are significantly higher in early pregnancy in women who later develop preeclampsia compared with women who do not develop preeclampsia. Data are reported as mean ± SD (error bars). *p = 0.001 and **p < 0.0001.