Letter to the Editor Open Access
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10384-10386
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10384
Are pregnancy-associated hypertensive disorders so sweet?
Costas Thomopoulos, Ioannis Ilias
Costas Thomopoulos, Department of Cardiology, Elena Venizelou General and Maternity Hospital, Athens GR-11521, Greece
Ioannis Ilias, Department of Endocrinology, Elena Venizelou General and Maternity Hospital, Athens GR-11521, Greece
ORCID number: Costas Thomopoulos (0000-0002-8491-6029); Ioannis Ilias (0000-0001-5718-7441).
Author contributions: Both Authors conceived, wrote and revised this submission.
Conflict-of-interest statement: Both Authors declare that they have no conflict of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ioannis Ilias, MD, PhD, Consultant Physician-Scientist, Department of Endocrinology, Elena Venizelou General and Maternity Hospital, 2, Elena Venizelou Square, Athens GR-11521, Greece. iiliasmd@yahoo.com
Received: April 18, 2022
Peer-review started: April 18, 2022
First decision: June 7, 2022
Revised: June 10, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: October 6, 2022

Abstract

Worldwide, one in seven pregnancies is complicated by some form of diabetes, with a rising trend. Additionally, hypertension is one of the main causes of morbidity and mortality for both the pregnant woman and the fetus and also contributes to premature birth. In a cohort study of pregnant women with diabetes, which was recently published in this journal, at least 84.5% of the subjects had hypertension. This rate of hypertension might be among the highest reported thus far. In the medical literature, approximately 20% of women with diabetes during pregnancy have various pregnancy-associated hypertensive disorders. Racial/ethnic differences, apparently, were not implicated in this elevated rate of hypertension: Although black and Hispanic women have a twofold higher rate of hypertension in pregnancy compared to white women, 75% of the subjects in the study in question were white. Thus, the impressive finding delivered by this large study, merits additional clarifications.

Key Words: Pregnancy, Hypertension, Pre-eclampsia, Diabetes, Gestational diabetes, Human

Core Tip: In a recent large study of pregnant women with diabetes, more than 84.5% of the subjects had hypertension, a rate which is fourfold higher than in the literature. Such a finding merits additional clarification.



TO THE EDITOR

We read with interest the paper by Xaverius et al[1] focusing on the association between different phenotypes of diabetic pregnancies and birth outcomes. In this paper, the authors considered, reasonably, gestational or chronic hypertension to be a confounding factor, because hypertension in pregnancy was related to both the predictor and outcome of their investigation. It is striking that most pregnant women with diabetes included in this study had hypertension (with rates ranging from 84.5% to 95.0%)[1]. To the best of our knowledge, this rate of hypertension might be among the highest reported thus far. A tentative explanation could be that racial/ethnic differences were implicated in this elevated rate of hypertension: black and Hispanic women have a twofold higher rate of hypertension in pregnancy compared to white women[2]. Nevertheless, approximately 75% of the population which was included in the study by Xaverius et al[1] were white. In the Control of Hypertension in Pregnancy Study (CHIPS), which included women with gestational or chronic hypertension[3], only 6% had gestational diabetes at enrollment, while in the recent Chronic Hypertension and Pregnancy (CHAP) trial, which included only women with chronic hypertension[4], the reported gestational diabetes rate was 15%. Additionally, in the literature, approximately 20% of women with diabetes during pregnancy have various pregnancy-associated hypertensive disorders[5-7]. Thus, in the study by Xaverius et al[1] the rate of hypertension in pregnancy is fourfold higher than in the literature. This impressive finding, delivered by this large pregnancy cohort[1], merits additional clarifications.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Endocrinology and metabolism

Country/Territory of origin: Greece

Peer-review report’s scientific quality classification

Grade A (Excellent): A

Grade B (Very good): 0

Grade C (Good): C

Grade D (Fair): D

Grade E (Poor): 0

P-Reviewer: He Z, China; Razzaque MS, United States; Tolunay HE, Turkey S-Editor: Chang KL L-Editor: Kerr C P-Editor: Chang KL

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