Pregnancy induced hypertension in women with gestational carbohydrate intolerance: the diagest study

Objective: To determine the relationship between pregnancy induced hypertension (PIH) and gestational glucose intolerance. Methods: A 50 1 h glucose loading test was offered to all pregnant women between 24 and 28 weeks of gestation in 15 centres in northern France during 8 months in 1992. If the test was positive (greater than or equal to7.2 mmol/l), the woman underwent a 3 h oral glucose tolerance test (OGTT) as soon as possible. Using the criteria of Carpenter and Coustan, gestational diabetes mellitus (GDM) was defined by two abnormal values (n = 218) and gestational mild hyperglycemia (GMH) by one abnormal value (n = 130). Each control group was defined by a 50 g, 1 h loading test result of <7.2 mmol/l (n = 108). PIH included gestational hypertension (GH) and preeclampsia (PE). GH was defined as a diastolic pressure of more than 85 mmHg on at least two occasions arising during pregnancy. PE was defined as GH with proteinuria greater than or equal to500 mg/24 h. Results: The rate of PIH in the three groups (GDM; GMH and control group, C) was, respectively 17.0, 10.8, and 4.6%. All the six PE occured in the GDM group. Univariate analysis showed significantly higher rate of hypertension in women with a history of PE, increasing body mass index before pregnancy (BMI) and glucose intolerance. In multivariate analysis with adjustment for primiparity, independant risk factors for PIH were a history of PE, BMI >27 and GDM, contrary to GMH and maternal age. Conclusions: PIH appears to be linked to the level of glucose intolerance during pregnancy, independently of other known factors of hypertension. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.