Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy
Open accessAbstract
BACKGROUND: Increasing diabetes prevalence affects a substantial number of pregnant women in the United States. Our aims were to evaluate health outcomes, medical costs, risks and types of complications associated with diabetes in pregnancy for mothers and newborns. METHODS: In this retrospective claims analysis, patients were identified from the Truven Health MarketScan(®) database (2004-2011 inclusive). Participants were aged 18-45 years, with ascertainable diabetes status [Yes/No], date of birth event >2005 and continuous health plan enrolment ≥21 months before and 3 months after the birth. RESULTS: In total, 839 792 pregnancies were identified, and 66 041 (7.86%) were associated with diabetes mellitus [type 1 (T1DM), 0.13%; type 2 (T2DM), 1.21%; gestational (GDM), 6.29%; and GDM progressing to T2DM (patients without prior diabetes who had a T2DM diagnosis after the birth event), 0.23%]. Relative risk (RR) of stillbirth (2.51), miscarriage (1.28) and Caesarean section (C-section) (1.77) was significantly greater with T2DM versus non-diabetes. Risk of C-section was also significantly greater for other diabetes types [RR 1.92 (T1DM); 1.37 (GDM); 1.63 (GDM progressing to T2DM)]. Risk of overall major congenital (RR ≥ 1.17), major congenital circulatory (RR ≥ 1.19) or major congenital heart (RR ≥ 1.18) complications was greater in newborns of mothers with diabetes versus without. Mothers with T2DM had significantly higher risk (RR ≥ 1.36) of anaemia, depression, hypertension, infection, migraine, or cardiac, obstetrical or respiratory complications than non-diabetes patients. Mean medical costs were higher with all diabetes types, particularly T1DM ($27 531), than non-diabetes ($14 355). CONCLUSIONS: Complications and costs of healthcare were greater with diabetes, highlighting the need to optimize diabetes management in pregnancy.
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The ongoing epidemic of obesity and diabetes has led to more type 2 diabetes in people of reproductive age, with an increase in pregnant individuals with undiagnosed type 2 diabetes in early pregnancy.
“The ongoing epidemic of obesity and diabetes has led to more type 2 diabetes in people of reproductive age, with an increase in the number of pregnant individuals with undiagnosed type 2 diabetes in early pregnancy (179 -181).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [181]
The Introduction reports increasing diabetes among women of child-bearing age, and the Results report a modest increase in T2DM among pregnant women since 2005. The Introduction’s estimate of undiagnosed diabetes concerns US adults generally, not pregnant individuals in early pregnancy. The cited passages do not establish that obesity caused the increase or that undiagnosed T2DM increased in early pregnancy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe ongoing epidemic of obesity and diabetes has led to more type 2 diabetes in people of reproductive age, with an increase in the number of pregnant individuals with undiagnosed type 2 diabetes in early pregnancy.
“The ongoing epidemic of obesity and diabetes has led to more type 2 diabetes in people of reproductive age, with an increase in the number of pregnant individuals with undiagnosed type 2 diabetes in early pregnancy (164-166).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [166]
The Introduction and Results report increasing type 2 diabetes among women of child-bearing age and pregnant women. The Introduction gives an estimate of undiagnosed diabetes only for US adults generally; it does not establish an increase among pregnant people in early pregnancy. The paper also does not attribute the increase to obesity. (LLM, conf=0.88)
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- Authors
- Jovanovič, L., Liang, Y., Weng, W., Hamilton, M., Chen, L., & Wintfeld, N.
- Affiliations
- Sansum Diabetes Research Institute Santa Barbara CA USA
- Novo Nordisk (United States) (US)
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2015-06-16
- Volume
- 31
- Issue
- 7
- Pages
- 707-716
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- PMC
- PMC4676929
- OpenAlex
- W1493539808
- Cited by
- 105
- References
- 26
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 5 · 2023: 8 · 2022: 12 · 2021: 14 · 2020: 20 · 2019: 12 · 2018: 9 · 2017: 5 · 2016: 7
- FWCI
- 7.97
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk Inc.
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes in pregnancy, gestational diabetes mellitus, type 1 diabetes, type 2 diabetes, pregnancy complications, stillbirth, miscarriage, cesarean section, congenital malformations, maternal outcomes, health care costs, maternal morbidity
- MeSH terms
- Congenital Abnormalities, Abortion, Spontaneous, Adolescent, Adult, Anemia, Cesarean Section, Depression, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Heart Defects, Congenital, Humans, Infant, Newborn, Middle Aged, Pregnancy, Pregnancy Complications, Cardiovascular, Pregnancy Complications, Hematologic, Pregnancy Complications, Infectious, Pregnancy in Diabetics, Pregnancy Outcome, Retrospective Studies, United States, Incidence, Diabetes, Gestational, Health Care Costs, Stillbirth, Young Adult
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