Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

Abstract

OBJECTIVEWomen with diabetes in pregnancy have high rates of pregnancy complications. Our aims were to explore trends in the incidence of diabetes in pregnancy and examine whether the risk of serious perinatal outcomes has changed. RESEARCH DESIGN AND METHODSWe performed a population-based cohort study of 1,109,605 women who delivered in Ontario, Canada, between 1 April 1996 and 31 March 2010. We categorized women as gestational diabetes (GDM) (n = 45,384), pregestational diabetes (pre-GDM) (n = 13,278), or no diabetes (n = 1,050,943). The annual age-adjusted rates of diabetes in pregnancy were calculated, and rates of serious perinatal outcomes were compared between groups and by year using Poisson regression. RESULTSThe age-adjusted rate of both GDM (2.7-5.6%, P < 0.001) and pre-GDM (0.7-1.5%, P < 0.001) doubled from 1996 to 2010. The rate of congenital anomalies declined by 23%, whereas the rate of perinatal mortality did not change significantly. However, compared with women with no diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (relative risk 1.86 [95% CI 1.49-2.33] and 1.26 [1.09-1.45], respectively), and perinatal mortality remained elevated in women with pre-GDM (2.33 [1.59-3.43]). CONCLUSIONSThe incidence of both GDM and pre-GDM in pregnancy has doubled over the last 14 years, and the overall burden of diabetes in pregnancy on society is growing. Although congenital anomaly rates have declined in women with diabetes, perinatal mortality rates remain unchanged, and the risk of both remains significantly elevated compared with nondiabetic women. Increased efforts are needed to reduce these adverse outcomes.Diabetes in pregnancy is becoming an increasingly growing concern as the prevalence of diabetes continues to rise (1). Women with diabetes who become pregnant have an increased risk of pregnancy complications (2-7), including serious perinatal outcomes such as stillbirth, perinatal mortality, and major congenital malformations. Hyperglycemia in the period around conception and the first weeks

Pregnancy and neonatal outcomes in women with type 1 diabetes mellitus

“…The incidence of congenital anomalies in infants of diabetic women is 4-10 times higher than that in non-diabetic population. It depends on metabolic compensation of DM (3,14,25,26). This fact was also demonstrated in our study, where in diabetic women with preparation for pregnancy, the frequency of congenital cardiac anomalies was 18 %, whereas in those without preparation for preg-nancy, it was 30 %.…”

Caring for pregnant women whose diabetes antedates pregnancy: is there room for improvement?

“…Since the mid-1990s, in parallel with the global increase in all forms of diabetes [1], regional [3,4] and national [5][6][7] data have demonstrated an increase in the proportions of pregnancies complicated by diabetes. In much of the world, a greater proportion of pregnant women with diabetes antedating pregnancy have type 2 diabetes, and the increase in the prevalence of diabetes during pregnancy is greater for type 2 (111-354%) than for type 1 (33-162%) diabetes [6][7][8] .…”

“…Populationbased studies examining trends in adverse pregnancy outcomes over long periods are sparse and there appears to be some discrepancy in findings. For example, one study [3] found an apparent decline in neonatal congenital malformations over time while another [8] did not. Likewise, a decrease in stillbirths over time was previously reported by one research group [8] but no differences were observed in another study [3].…”

“…For example, one study [3] found an apparent decline in neonatal congenital malformations over time while another [8] did not. Likewise, a decrease in stillbirths over time was previously reported by one research group [8] but no differences were observed in another study [3]. In another report, a decrease over time in fetal overgrowth has been noted for women with type 1, but not type 2 diabetes [7].…”

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

“…Presently, the prevalence of type 1 diabetes in pregnancy is increasing along with type 2 and gestational diabetes [8][9][10]. Several studies have evaluated the clinical relevance of White's classification [7,[11][12][13].…”