ViewpointType 2 diabetes in pregnancy: a growing concern
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
References (20)
- et al.
Current status of pregnancy in diabetic women: a comparison of pregancy in IDDM and NIDDM mothers
Diabetes Res Clin Pract
(1994) - et al.
The management of non-insulin dependent diabetes during pregnancy
Diab Res Clin Pract
(1985) - et al.
Should the same glucose values be targeted for type 1 as for type 2 diabetics in pregnancy?
Am J Ostet Gynecol
(1997) - et al.
Emerging epidemic of type 2 diabetes in youth
Diabetes Care
(1999) - et al.
Diabetes trends in the US: 1990-1998
Diabetes Care
(2000) Diabetes and impaired glucose tolerance in women aged 20-39 years
World Health Stat Q
(1992)- et al.
Gestational diabetes: infant and maternal complications of pregnancy in relation to thirdtrimester glucose tolerance in the Pima Indians
Diabetes Care
(1980) - et al.
The epidemiology of diabetes in pregnant Native Canadians
Diabetes Care
(1997) - et al.
Diabetes mellitus in Tohono O'odham pregnancies
Diabetes Care
(1993) - et al.
The epidemiology of diabetes and pregnancy in the US, 1988
Diabetes Care
(1995)
Cited by (181)
MicroRNA-322 overexpression reduces neural tube defects in diabetic pregnancies
2024, American Journal of Obstetrics and GynecologyCorrelations between serum BDNF levels and neurodevelopmental outcomes in infants of mothers with gestational diabetes
2021, Pediatrics and NeonatologyCitation 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.
Pregnancy-induced Cardiovascular Pathologies: Importance of Structural Components and Lipids
2020, American Journal of the Medical SciencesGestational Diabetes and Type 2 Diabetes During Pregnancy
2020, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical ManagementGestational Diabetes and Type 2 Diabetes During Pregnancy
2019, Maternal-Fetal and Neonatal Endocrinology: Physiology, Pathophysiology, and Clinical ManagementPre-Conceptional and Antenatal Care for Improved Newborn and Child Survival in India: A Review
2023, Indian Journal of Pediatrics