Association of the Presence of Microangiopathy with Adverse Pregnancy Outcome in Type 1 Diabetes: A Meta-analysis

Objective: Microangiopathy is common after a long duration in type 1 diabetes mellitus (T1DM). Pregnancies with end-age vascular complications are a big challenge to multidisciplinary physicians. The objective of this study was to assess the risk of microangiopathy for adverse pregnancy outcome in T1DM.

Materials And Methods: PubMed, EMBASE, and Cochrane Library databases were searched for relevant articles appearing in the literature up to October 1, 2017. Analysis of cohort studies were performed with Review Manager 5.3 and Newcastle Ottawa Scale (NOS) was chosen to evaluate the risk of bias.

Results: A total of 10 studies involving 3239 pregnancies were retrieved and analyzed. Microangiopathy for diabetic nephropathy (DN), microalbuminuria and diabetic retinopathy (DR) significantly increased the risk of preeclampsia (PE) (OR of 7.19, [95%CI: 5.15, 10.03], 4.19, [95%CI: 2.78, 6.31] and 3.02, [95%CI: 2.24, 4.07], respectively). Significant association of the presence of DN with preterm delivery was demonstrated (OR = 4.14, 95%CI [2.84, 6.02]), with small for gestation age was demonstrated (OR = 6.23, 95%CI [2.75, 14.14]) and with large for gestation age was demonstrated (OR = 0.41, 95%CI [0.27, 0.62]). A mild association of the presence of DR with preterm delivery was demonstrated (OR = 1.57, 95%CI [1.08, 2.29]).

Conclusion: The presence of microangiopathy before or in early pregnancy increased the risk of adverse pregnancy outcome in T1DM. We highlighted it was important that White's classification and a full assessment of vasculopathy should be carry out before pregnancy to ensure a well-planned pregnancy. Further work should be designed to establish risks model involving microangiopathy and find out whether early intervention with strict blood sugar control or medication such as low-dose aspirin will reduce the incidence of PE in T1DM.