Elsevier

The Lancet

Volume 359, Issue 9318, 11 May 2002, Pages 1690-1692
The Lancet

Viewpoint
Type 2 diabetes in pregnancy: a growing concern

https://doi.org/10.1016/S0140-6736(02)08599-9Get rights and content

Section snippets

Increasing prevalence of type 2 diabetes in younger populations

The global prevalence of type 2 diabetes is increasing. Although there are currently 110 million people with diabetes around the world, most of whom have type 2 diabetes, this number is expected to double by the year 2010. Additionally, the demographic pattern of type 2 diabetes is changing, with a shift to a younger age of onset. Over the past 10 years, more women of childbearing age, adolescents, and even children have developed type 2 diabetes,1 and a study of diabetes prevalence in the USA

Correct identification of type 2 diabetes in pregnancy

The true prevalence of type 2 diabetes in pregnancy has been very difficult to estimate for several reasons. First, the figures for “pregestational diabetes” frequently include patients with either type 1 or type 2 diabetes. Often women are assumed to have type 1 diabetes in pregnancy if they are taking insulin. This assumption might be valid when referring to populations in which the relative prevalence of type 1 diabetes is high—eg, in Sweden and Finland. However, for populations in which the

prevalence of type 2 diabetes in pregnancy

Three studies have measured the prevalence of type 2 diabetes in pregnancy, either by testing of populations, or by survey. In a prospective study of 811 pregnancies in the Pima Indians of Arizona, 6·3 were known to have diabetes before pregnancy.5 A retrospective analysis of type 2 diabetes in pregnancy in the Ojibwa-Cree of northwestern Ontario, Canada, yielded a prevalence of 3·2%. The Canadian study probably underestimated the prevalence, since it included only women who were diagnosed

Maternal and fetal complications of type 2 diabetes during pregnancy

There is evidence that rising rates of type 2 diabetes in pregnancy could lead to increasing numbers of complications in pregnancy, for both mothers and fetuses. Type 2 diabetes is being recognised as representing at least as significant a risk to both mother and baby as does type 1 diabetes.

Effectiveness of diabetes control in pregnancy

The rate of congenital anomalies in patients with type 1 diabetes can be reduced to that of the general population if excellent glycaemic control is achieved at the time of conception. This control has been achieved in circumstances of tertiary care in specialised centres. However, in population studies, clinicians have not been nearly as successful in preventing congenital anomalies.15, 16 In two recent population studies done in the UK, rates of congenital anomaly and perinatal mortality were

Diabetes begets diabetes

The prevalence of type 2 diabetes in children and adolescents is increasing, especially in populations with a very high overall prevalence of the disease.1 There is some evidence that diabetes in pregnancy might have a role in this increased prevalence. In a study of type 2 diabetes among Pima Indian children, the prevalence rose significantly between 1967 and 1996.18 This increase was felt to be due to an increase in weight seen in the children, as well as an increased frequency of exposure to

Conclusions

With the growing epidemic of type 2 diabetes in pregnancy, we should be concerned. The higher rates of type 2 diabetes in pregnancy bring with them higher rates of maternal and fetal morbidity, and might even contribute to the increasing incidence of type 2 diabetes in the world. Better recognition of this growing entity by family physicians and primary-care internists who see these patients before pregnancy, and a heightened awareness of the need for prepregnancy counselling about

First page preview

First page preview
Click to open first page preview

References (20)

There are more references available in the full text version of this article.

Cited by (181)

  • Correlations between serum BDNF levels and neurodevelopmental outcomes in infants of mothers with gestational diabetes

    2021, Pediatrics and Neonatology
    Citation Excerpt :

    The infants of mothers with gestational diabetes (IMGD), besides having increased risk for mortality and morbidity, tended to have a long-term outcome of increasing the risk of postnatal neurodevelopment outcome.4,5 Furthermore, IMGD were also noted to have a relatively lower IQ, and a higher risk of attention-deficit hyperactivity disorder which may begin to develop during the perinatal period.6–10 Consequently, the long-term effects of maternal diabetes during pregnancy on the offspring's outcomes have subsequently become a significant issue.

  • Gestational Diabetes and Type 2 Diabetes During Pregnancy

    2020, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical Management
  • Gestational Diabetes and Type 2 Diabetes During Pregnancy

    2019, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical Management
View all citing articles on Scopus
View full text