Gestational diabetes mellitus complicated by preeclampsia in the Czech Republic: A case case study

Background Gestational diabetes mellitus (GDM) and preeclampsia (PE) are serious complications of pregnancy. In a proportion of women, they coexist; however, it is not entirely clear whether they share common pathophysiological mechanisms. The reported incidence of PE in the Czech Republic is about 4–6% and its overlap with GDM has not been studied yet. The aim of the study was (i) to determine the prevalence of PE in healthy pregnant women and GDM patients, (ii) to determine the prevalence of PE in a group of patients with GDM with persisting glucose intolerance (PGI) postpartum and (iii) to determine whether GDM patients with PE have a higher risk of obstetric complications than other subgroups. Methods The study included 861 women enrolled in the period 2013–2019 (409 healthy women and 452 women with GDM) with data about delivery available in 74.8% (n = 644). GDM was diagnosed according to IADPSG criteria, PE according to ISSHP criteria. Following peripartal parameters were evaluated: the necessity of induction, the length of labour (protracted birth), the use of the instruments during delivery (section, pliers, vacuum extractor), Apgar Score (pathology), the weight of the child (macrosomia). Patients with GDM were monitored at the Diabetology Centre of the University Hospital Brno until birth. Postpartum, 48.5% (n = 219) of GDM patients underwent repeated oGTT up to 1 year after delivery, of which 11.4% (n = 25) were confirmed as PGI (according to WHO criteria). Results PE was diagnosed in 4.6% (n = 19) controls and 10.4% (n = 47) GDM patients (P 0.022, Chi square test. Occurrence of PE was 20% in PGI group. The presence of PE also affected the course of birth - patients with PE more often have a (planned) Caesarean delivery and childbirth was more often prematured. Conclusion The incidence of PE in GDM patients was statistically significantly higher (approx. doubled) than in the control group (p = 0.022 Chi square) and PE negatively affected the course of birth. In patients with PGI after delivery, the occurrence of PE was very high and PE can be considered an independent risk factor for PGI.