Diabetes in Pregnancy
Burden of Disease
Diabetes in Pregnancy:
Epidemiology
Diabetes in Pregnancy
1995 CDC Data1
• 2%-10% of pregnancies currently are
complicated by gestational diabetes
mellitus (GDM)
• New diagnostic criteria estimated to
increase rate to 18%2,3,4
Type 1
Diabetes
4%
Type 2
Diabetes
8%
Gestational
Diabetes
Mellitus
88%
• The prevalence of both GDM and type
2 diabetes mellitus have increased as
obesity and sedentary lifestyle have
increased in the United States5
• Pregnancies complicated by preexisting
diabetes have increased substantially;
most likely due to increased prevalence
of T2DM in younger patients6,7
1. Engelgau, MM, et al. Diabetes Care. 1995;18(7):1029-33. 2. CDC. National Diabetes Fact Sheet 2011. CDC.
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 2011. Accessed: April 26, 2012. 3. ADA. What is Gestational Diabetes?
ADA. http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html. 2010. Accessed: April 26, 2012.
4. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66. 5. Chitayat L, et al. Diabetes Technol Ther. 2009;11:S105-111.
6. Pinhas-Hamiel O, Zeitler P. Pediatric Diabetes. 2007;8(9):16-27. 7. National Diabetes Education Program. Overview of Diabetes in
Children and Adolescents. NIH. http://ndep.nih.gov/media/Youth_factsheet.pdf. June 2011. Accessed: April 26, 2012.
Morbidity and Mortality
Risks Associated With Diabetes in Pregnancy
Maternal Risks
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Preeclampsia1
Increased caesarean delivery1
Subsequent development of T2DM1
30% maternal mortality rate2
Progression of chronic complications of
diabetes4
Gestational hypertension5
Hypoglycemia1
Infection (eg, pyelonephritis)6,7
Ketoacidosis6,7
Polyhydramnios6,7
Preterm labor6,7
Seizures4,6
Doubled spontaneous abortion risk4
Maternal birth weight <4 lbs 7 oz9
Fetal Risks
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Birth injuries1,7
Childhood obesity1,7
Hyperbilirubinemi1,7
Hypoglycemia1,7
Macrosomia1,7
Shoulder dystocia1,7
Respiratory distress syndrome1,7
Premature birth1,7
Increased cord-blood serum C-peptide
levels1,7
Abnormal birth weight (low or high)4
Increased risk of T2DM and/or GDM later
in life8
Increased congenital malformations4
1. Committee on Obstetric Practice. ACOG. 2011;504:1-3. 2. Jovanovic L. Insulin therapy in pregnancy. In: Leahy JL, Cefalu
WT, eds. Insulin Therapy. New York, NY: Marcel Dekker Inc; 2002:139-151. 3. Jovanovic L, Peterson CM. Diabetes Care.
1982;5(1):24-37. 4. AACE. Endocr Pract. 2011;17(2):1-53. 5. Metzger BE, et al. Diabetes Care, 2007;30(2):S251- 60.
6. Jovanovic L, et al. Mt Sinai J Med. 2009;76(3):269-80. 7. Castorino K et al. Curr Diab Rep, 2012;12:53-59.
8. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66. 9. Inness KE, et al. JAMA. 2002;287(19):2534-41.
GDM: Pathophysiology
Late pregnancy:
Insulin resistance due to
placental secretion of antiinsulin hormones1
• Maternal hepatic glucose
production increases by
15%-30% to meet fetal
demand1
Pancreatic betacell dysfunction
caused by:
Combination of:
• Glucose
intolerance
• Hyperglycemia
• Beta-cell
dysfunction2
• Genetics
• Autoimmune
disorders
• Chronic insulin
resistance1,2
Gestational
diabetes
mellitus
(GDM)
1.
Inturrisi M, et al. Endocrinol Metab Clin N Am. 2011;40:703-26.
2. Metzger BE, et al. Diabetes Care. 2007;30(2):S251- 60.
GDM: Etiology and Risk
Factors
• Hormonally induced insulin resistance
• Resulting in hyperglycemia
• Eventually progresses into diabetes
Etiology
Gestational
diabetes mellitus
(GDM) risk
factors1,2
• Obesity
• Previous history of GDM
• Prior delivery of a large baby (>9 lbs)
• Glycosuria
• Family history of diabetes in a first-degree relative
Risk of future
T2DM
• 5%-10% of women with GDM develop T2DM
immediately postpartum6
• 35%-60% chance of T2DM over next 10-20 years6
• Risk increased with uncontrolled blood sugar in
pregnancy5
1. American Diabetes Association. Diabetes Care. 2004;27(1):S88-S90. 2. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66. 3.
Inturrisi M, et al. Endocrinol Metab Clin N Am. 2011;40:703-26. 4. Metzger BE, et al. Diabetes Care. 2007;30(2):S251- 60. 5.
Committee on Obstetric Practice. ACOG. 2011;504:1-3. 6. CDC. National Diabetes Fact Sheet 2011. CDC.
Http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 2011. Accessed: April 26, 2012 .
Cost-Effectiveness of New
Screening Criteria
• International Association of the Diabetes and
Pregnancy Study Groups (IADPSG) has
proposed new screening criteria for gestational
diabetes mellitus (GDM)
– For every 100,000 women screened under the
updated criteria, 6,178 quality-adjusted life-years
(QALYs) will be gained at a cost of approximately
$126 million
– Compared with current GDM screening practices,
the new IADPSG strategy has an incremental
cost-effectiveness ratio (ICER) of $20,336 per
QALY gained
1. Werner EF, et al. Diabetes Care. 2012;35:529-35.