# Clinical implications of a history of pre‐eclampsia in women with type two diabetes mellitus

## TL;DR

Women with a history of pre-eclampsia develop type 2 diabetes earlier and face higher risks of complications, requiring more aggressive care.

## Contribution

This study reveals how pre-eclampsia history uniquely affects type 2 diabetes progression and microvascular outcomes.

## Key findings

- Women with a PE history were diagnosed with T2D 3.2 years earlier and had higher BMI and blood pressure.
- A PE history was linked to a 26% increased risk of microvascular complications like retinopathy and kidney disease.
- Women with PE history developed cardiovascular disease and all-cause death about 5 years earlier than others.

## Abstract

The consequences of pre‐eclampsia (PE) are not limited to pregnancy; a single episode predisposes mothers to serious future health outcomes. Little is known about how PE impacts the course of type 2 diabetes (T2D) and associated microvascular diseases.

The Scottish Care Information for Diabetes data for individuals with diabetes in NHS Tayside and Fife was linked with Scottish maternity morbidity records. A nested case–control study compared BMI, HDL cholesterol, systolic blood pressure(SBP) and HbA1c measures at T2D diagnosis between women with prior pregnancies from 1921 to 2022 affected or unaffected by PE using linear regression and adjusted for the other aforementioned variables. Cox regression models assessed how a PE history influenced the risk of future microvascular complications following T2D diagnosis.

In total, 6055 women were eligible: 726 (12%) had a PE‐pregnancy and 5329 (88%) had only PE‐free pregnancies, with ~20 years between pregnancy and T2D diagnosis. At T2D diagnosis, women with a PE history had higher BMI (38.3 kg/m2 vs. 35.7 kg/m2, p < 0.001), higher SBP (139 mmHg vs. 135 mmHg, p < 0.001), lower HDL cholesterol (1.18 mmol/L vs. 1.21 mmol/L, p = 0.002) and were diagnosed 3.2 years earlier (p < 0.001). A PE history was associated with increased microvascular disease risk (HR 1.26 95% CI 1.12–1.42, p < 0.001): diabetic retinopathy (HR 1.22 95% CI 1.07–1.38, p = 0.003); chronic kidney disease (HR 1.35 95% CI 1.06–1.71, p = 0.016); diabetic proteinuric kidney disease (HR 2.45 95% CI 1.03–5.81, p < 0.001). Women with a PE history were ~5 years younger when they developed cardiovascular disease (55.7 years vs. 60.6 years, p < 0.001) and all‐cause death (60.1 years vs. 65.6 years, p < 0.0001).

At T2D diagnosis, women with a PE history are younger, with more severe clinical presentations and increased risk of developing T2D microvascular complications. This highlights the crucial need for changes to the long‐term care of this high‐risk group, with aggressive risk‐factor management and continued clinical assessment.