Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy

Abstract

BackgroundIncreasing diabetes prevalence affects a substantial number of pregnant women in the United States. Our aims were to evaluate health outcomes, medical costs, risks and types of complications associated with diabetes in pregnancy for mothers and newborns.MethodsIn this retrospective claims analysis, patients were identified from the Truven Health MarketScan® database (2004–2011 inclusive). Participants were aged 18–45 years, with ascertainable diabetes status [Yes/No], date of birth event >2005 and continuous health plan enrolment ≥21 months before and 3 months after the birth.ResultsIn total, 839 792 pregnancies were identified, and 66 041 (7.86%) were associated with diabetes mellitus [type 1 (T1DM), 0.13%; type 2 (T2DM), 1.21%; gestational (GDM), 6.29%; and GDM progressing to T2DM (patients without prior diabetes who had a T2DM diagnosis after the birth event), 0.23%]. Relative risk (RR) of stillbirth (2.51), miscarriage (1.28) and Caesarean section (C-section) (1.77) was significantly greater with T2DM versus non-diabetes. Risk of C-section was also significantly greater for other diabetes types [RR 1.92 (T1DM); 1.37 (GDM); 1.63 (GDM progressing to T2DM)]. Risk of overall major congenital (RR ≥ 1.17), major congenital circulatory (RR ≥ 1.19) or major congenital heart (RR ≥ 1.18) complications was greater in newborns of mothers with diabetes versus without. Mothers with T2DM had significantly higher risk (RR ≥ 1.36) of anaemia, depression, hypertension, infection, migraine, or cardiac, obstetrical or respiratory complications than non-diabetes patients. Mean medical costs were higher with all diabetes types, particularly T1DM ($27 531), than non-diabetes ($14 355).ConclusionsComplications and costs of healthcare were greater with diabetes, highlighting the need to optimize diabetes management in pregnancy. © 2015 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons, Ltd.

Gestational diabetes mellitus: does treatment modality predict the obstetric and neonatal outcome?

“…Gestational diabetes mellitus was found to be present in 6.7 in the present study which was similar to 6.3% in an American study by Jovanovic et al 3 Previous bad obstetric history in the form of recurrent abortions and intrauterine deaths were significantly higher in patients with GDM when compared to those with overt diabetes in an Indian study by Uma et al 1 In another study by Koning et al where they have compared the obstetric history in patients with GDM on diet and insulin respectively, a stronger association was found with intrauterine foetal death in cases of GDM treated with insulin. 4 Similar results were found by Feleke in his study of determinants of gestational diabetes mellitus.…”

“…The need for emergency Caesarean sections was significantly higher in the GDM women in the study by Jovanovic et al 3 Similar results were obtained in their study by Gasim et al and Billionet et al 6,7 The French study has commented that GDM women requiring insulin therapy underwent emergency Caesarean sections more frequently compared to the diet therapy group. Our present study also shows similar results, however the indication of foetal distress was higher in group A compared to group B.…”

“…2 GDM has been associated with higher number of adverse maternal outcomes like abortions, preterm deliveries, gestational hypertension, increased need for Caesarean sections, as well macrosomia, stillbirth and congenital malformations in babies. 3 Regarding management of this condition, the treatment guidelines are followed which stress the importance of good glycaemic control for a favourable outcome for the mother and baby. The well accepted first line of management for this condition is dietary advice and if this modality alone fails to achieve a satisfactory glycaemic control, then treatment with insulin is given to get the required results.…”

Glucose- and temperature-sensitive nanoparticles for insulin delivery

“…3 Over the past 20 years, the incidence of diabetes has increased sharply. 4 The development of new and more effective treatment regimens is hence urgent.…”

Postpartum care and contraception provided to women with gestational and preconception diabetes in California's Medicaid program

“…Although there is no ideal rate of contraceptive use among women with diabetes, contraceptive use among women with diabetes should not be lower than among women without diabetes, because diabetes increases risks of pregnancy complications [8]. As DM is increasingly common during pregnancy [11], and DM has been a focus of quality improvement projects for the state of California, the purpose of this study was to assess associations between maternal diabetes (either preconception or gestational) and rates of postpartum care and contraception, compared to women with no known diabetes.…”