Trends in Prevalence of Diabetes Among Delivery Hospitalizations, United States, 1993–2009

Abstract

To describe recent trends in prevalence of pre-existing diabetes mellitus (PDM) (i.e., type 1 or type 2 diabetes) and gestational diabetes mellitus (GDM) among delivery hospitalizations in the United States. Data on delivery hospitalizations from 1993 through 2009 were obtained from the Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Diagnosis-Related Group codes were used to identify deliveries and diagnosis codes on presence of diabetes. Rates of hospitalizations with diabetes were calculated per 100 deliveries by type of diabetes, hospital geographic region, patient’s age, degree of urbanicity of patient’s residence, categorized median household income for patient’s ZIP Code, expected primary payer, and type of delivery. From 1993 to 2009, age-standardized prevalence of diabetes per 100 deliveries increased from 0.62 to 0.90 for PDM (trend p < 0.001) and from 3.09 to 5.57 for GDM (trend p < 0.001). In 2009, correlates of PDM at delivery included older age [40–44 vs. 15–24: odds ratio 6.45 (95 % CI 5.27–7.88)], Medicaid/Medicare versus private payment sources [1.77 (95 % CI 1.59–1.98)], patient’s ZIP Code with a median household income in bottom quartile versus other quartiles [1.54 (95 % CI 1.41, 1.69)], and C-section versus vaginal delivery [3.36 (95 % CI 3.10–3.64)]. Correlates of GDM at delivery were similar. Among U.S. delivery hospitalizations, the prevalence of diabetes is increasing. In 2009, the prevalence of diabetes was higher among women in older age groups, living in ZIP codes with lower household incomes, or with public insurance.

Trends in Gestational Diabetes Among Hospital Deliveries in 19 U.S. States, 2000–2010

“…1,2 Gestational diabetes mellitus (GDM), defined as diabetes first diagnosed during pregnancy, has been associated with numerous adverse perinatal outcomes such as macrosomia, or larger-than-normal babies, 3 which leads to difficult labor and delivery 4 and maternal morbidity. 5 The risk of developing GDM is increased in women with the following risk factors: age >25 years, non-white race, family history of diabetes, 6 GDM in a previous pregnancy, chronic hypertension, 7 high BMI, large abdominal circumference, high fasting glycemia in the first trimester of pregnancy, and the presence of polycystic ovary syndrome.…”

Pregestational Diabetes Mellitus and Congenital Heart Defects

“…There is no evidence in the published literature of recent decreases in the prevalence of CHDs among births in the general population or among births to women with pregestational diabetes mellitus. On the other hand, reports of increasing trends in the prevalence of pregnancies complicated by pregestational diabetes mellitus [33][34][35][36] have raised questions about the potential impact of such trends on the prevalence of diabetes mellitus-associated CHDs.…”

Cardiovascular disease screening

“…12,[15][16][17][18] Gestational diabetes affects up to 5% of pregnancies and is associated with an increased risk of CVD later in life. 19,20 Gestational diabetes is highly predictive of developing Type 2 diabetes in the post-partum period, with one meta-analysis attributing a sevenfold increased risk of Type 2 diabetes among women with a history of gestational diabetes. 21,22 Type 2 diabetes is a known risk factor for CVD.…”