Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 25, 2016; 7(12): 252-259
Published online Jun 25, 2016. doi: 10.4239/wjd.v7.i12.252
Does parity worsen diabetes-related chronic complications in women with type 1 diabetes?
Marilia Brito Gomes, Carlos Antonio Negrato, Ana Almeida, Antonio Ponce de Leon
Marilia Brito Gomes, Ana Almeida, Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro 20550-900, Brazil
Carlos Antonio Negrato, Bauru’s Diabetics Association, Bauru, São Paulo 17012-433, Brazil
Antonio Ponce de Leon, Department of Epidemiology, State University of Rio de Janeiro, Rio de Janeiro 20550-900, Brazil
Author contributions: Gomes MB, Negrato CA, Almeida A and de Leon AP analyzed the data and wrote the manuscript; Almeida A collected the data.
Supported by The Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil, No. 563753/2010-2.
Institutional review board statement: The study was reviewed and approved by the State University of Rio de Janeiro Institutional Review Board and Bauru’s Diabetics Association Institutional Review Board.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interests to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Carlos Antonio Negrato, MD, PhD, Bauru’s Diabetics Association, Rua Saint Martin 27-07, Bauru, São Paulo 17012-433, Brazil. carlosnegrato@uol.com.br
Telephone: +55-14-32348915 Fax: +55-14-32348915
Received: December 15, 2015
Peer-review started: December 18, 2015
First decision: February 29, 2016
Revised: March 31, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: June 25, 2016
Processing time: 183 Days and 18.8 Hours
Abstract

AIM: To determine the relationship between parity, glycemic control, cardiovascular risk factors and diabetes-related chronic complications in women with type 1 diabetes.

METHODS: This was a multicenter cross-sectional study conducted between December 2008 and December 2010 in 28 public clinics in 20 cities from the 4 Brazilian geographic regions. Data were obtained from 1532 female patients, 59.2% Caucasians, and aged 25.2 ± 10.6 years. Diabetes duration was of 11.5 ± 8.2 years. Patient’s information was obtained through a questionnaire and a chart review. Parity was stratified in five groups: Group 0 (nulliparous), group 1 (1 pregnancy), group 2 (2 pregnancies), group 3 (3 pregnancies), group 4 (≥ 4 pregnancies). Test for trend and multivariate random intercept logistic and linear regression models were used to evaluate the effect of parity upon glycemic control, cardiovascular risk factors and diabetes-related complications.

RESULTS: Parity was not related with glycemic control and nephropathy. Moreover, the effect of parity upon hypertension, retinopathy and macrovascular disease did not persist after adjustments for demographic and clinical variables in multivariate analysis. For retinopathy, the duration of diabetes and hypertension were the most important independent variables and for macrovascular disease, these variables were age and hypertension. Overweight or obesity was noted in a total of 538 patients (35.1%). A linear association was found between the frequency of overweight or obesity and parity (P = 0.004). Using a random intercept multivariate linear regression model with body mass index (BMI) as dependent variable a borderline effect for parity (P = 0.06) was noted after adjustment for clinical and demographic data. The observed variability of BMI was not attributable to differences between centers.

CONCLUSION: Our results suggest that parity has a borderline effect on body mass index but does not have an important effect upon hypertension and micro or macrovascular chronic complications. Future prospective evaluations must be conducted to clarify the relationship between parity, appearance or worsening of diabetes-related chronic complications.

Keywords: Type 1 diabetes; Parity; Glycemic control; Cardiovascular risk factors; Diabetes-related chronic complications

Core tip: To the best of our knowledge, this was the largest study ever conducted with pregnant women with type 1 diabetes in Brazil and maybe in Latin America. Our results suggest that parity did not have an important effect upon hypertension and micro or macrovascular diabetes-related chronic complications. Further prospective studies with a larger number of patients must be addressed to clarify the relationship between parity, appearance or worsening of diabetes-related chronic complications.