Occurrence and recurrence of diabetes in pregnancy

Abstract

word count: 244 Manuscript word count: 2, 996Number of figures: 1 Number of tables: 2 2 Abstract Aims: To determine occurrence and recurrence rates of gestational diabetes (GDM) and preexisting diabetes mellitus (PDM) among women having at least two consecutive pregnancies and to assess risk factors that contribute to GDM recurrence.Methods: Population-based study using longitudinally linked hospital discharge and birth records (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) in NSW, Australia. Participants included women without a pre-existing diagnosis of Type 1 or Type II diabetes at time of first pregnancy and with at least a first and second birth. Factors associated with GDM recurrence were examined using multivariate logbinomial models to adjust for correlation within mothers and estimate relative risks (RR) and 95% confidence intervals.Results: First occurrence of GDM was 3.7% (5 315/142 843) in the first pregnancy and 2.7% (3 689/137 528) in the second pregnancy. The recurrence rate of GDM in a second consecutive pregnancy was 41.2%. Risk of PDM in a pregnancy subsequent to one with first occurrence of GDM was 2.2% and 2.0% in the second or third pregnancy, respectively. Among women with a GDM diagnosis in the first pregnancy, independent predictors of GDM recurrence were maternal age ≥35 years, ethnicity (Middle East/North Africa and Asia), pregnancy hypertension, large for gestational age infant and preterm birth in the first pregnancy, longer interpregnancy birth interval and pregnancy hypertension and multiple pregnancy in the second pregnancy. Conclusions:Women with a first pregnancy complicated by GDM have elevated recurrence rates and require screening, active management and monitoring in between and during subsequent pregnancies.

The prevalence of gestational diabetes mellitus: The accuracy of the NSW perinatal data collection based on a private hospital experience

“…Given that other studies have found similar rates of under-reporting in the official databases, 8,15 these support a systemic issue. Failure to document the true prevalence of GDM may impact on healthcare delivery and outcomes.…”

From screening to postpartum follow-up – the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review

“…The diagnosis of GDM should initiate a long-term intervention and diagnostic process to minimize the risk of developing diabetes or to diagnose it as early in the course of disease as possible [80]. Moreover, women with one GDM affected pregnancy are at high risk of developing GDM in subsequent pregnancies [84]. The need to address barriers to postpartum follow-up and lifestyle modifications are therefore imperative.…”

Estimating the Recurrence Rate of Gestational Diabetes Mellitus (GDM) in Massachusetts 1998–2007: Methods and Findings

“…A number of randomized trials have demonstrated that medication [11–13] and/or weight loss [12, 13] and increased physical activity [13] reduce the risk of type 2 diabetes in high-risk individuals, including women with previous GDM [14]. However, very limited epidemiological information exists on the recurrence rates for GDM; the few extant studies use very different types of samples, methodologies and GDM criteria and then report greatly varying rates of GDM recurrence [5, 8, 15–19]. In a recent study from 20 Utah hospitals from 2002 to 2010, Boghossian et al [5] used medical records to identify cases of GDM.…”

“…McGuire et al [15] found that the risk of developing GDM in the pregnancy following two GDM-affected pregnancies was greatly increased compared with women without GDM in the previous two pregnancies (OR = 23.2, 95 % CI 17.2–31.2). A more recent population-based study from New South Wales Australia from 2001 to 2008 reported a GDM recurrence rate of 41 % [19]. Progression of GDM to chronic diabetes mellitus (CDM) across sequential pregnancies is even less well studied, especially in population-based data [10].…”