Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996-2014

Peng, Tiffany Y.; Ehrlich, Samantha F.; Crites, Yvonne; Kitzmiller, John L.; Kuzniewicz, Michael W.; Hedderson, Monique M.; Ferrara, Assiamira

doi:10.1016/j.ajog.2016.10.007

Cited by 94Gestational Diabetes Research and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Research

Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996-2014

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Peng, Tiffany Y., Ehrlich, Samantha F., Crites, Yvonne, Kitzmiller, John L., Kuzniewicz, Michael W., Hedderson, Monique M., Ferrara, Assiamira·2017·American Journal of Obstetrics and Gynecology

DOI 10.1016/j.ajog.2016.10.007PMC PMC5290002

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Abstract

Background Despite concern for adverse perinatal outcomes in women with diabetes mellitus before pregnancy, recent data on the prevalence of pregestational type 1 and type 2 diabetes mellitus in the United States are lacking.Objective The purpose of this study was to estimate changes in the prevalence of overall pregestational diabetes mellitus (all types) and pregestational type 1 and type 2 diabetes mellitus and to estimate whether changes varied by race-ethnicity from 1996-2014.Study design We conducted a cohort study among 655,428 pregnancies at a Northern California integrated health delivery system from 1996-2014. Logistic regression analyses provided estimates of prevalence and trends.Results The age-adjusted prevalence (per 100 deliveries) of overall pregestational diabetes mellitus increased from 1996-1999 to 2012-2014 (from 0.58 [95% confidence interval, 0.54-0.63] to 1.06 [95% confidence interval, 1.00-1.12]; P trend <.0001). Significant increases occurred in all racial-ethnic groups; the largest relative increase was among Hispanic women (121.8% [95% confidence interval, 84.4-166.7]); the smallest relative increase was among non-Hispanic white women (49.6% [95% confidence interval, 27.5-75.4]). The age-adjusted prevalence of pregestational type 1 and type 2 diabetes mellitus increased from 0.14 (95% confidence interval, 0.12-0.16) to 0.23 (95% confidence interval, 0.21-0.27; P trend <.0001) and from 0.42 (95% confidence interval, 0.38-0.46) to 0.78 (95% confidence interval, 0.73-0.83; P trend <.0001), respectively. The greatest relative increase in the prevalence of type 1 diabetes mellitus was in non-Hispanic white women (118.4% [95% confidence interval, 70.0-180.5]), who had the lowest increases in the prevalence of type 2 diabetes mellitus (13.6% [95% confidence interval, -8.0 to 40.1]). The greatest relative increase in the prevalence of type 2 diabetes mellitus was in Hispanic women (125.2% [95% confidence interval, 84.8-174.4]), followed by African American women (102.0% [95% confidence interval, 38.3-194.3]) and Asian women (93.3% [95% confidence interval, 48.9-150.9]).Conclusions The prevalence of overall pregestational diabetes mellitus and pregestational type 1 and type 2 diabetes mellitus increased from 1996-1999 to 2012-2014 and racial-ethnic disparities were observed, possibly because of differing prevalence of maternal obesity. Targeted prevention efforts, preconception care, and disease management strategies are needed to reduce the burden of diabetes mellitus and its sequelae.

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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: Standards of Care in Diabetes—2024 (2024) · cites this paper as [180]
The Comments section reports rising pregestational type 2 diabetes and suggests that increasing obesity among women of reproductive age likely contributed. But the Materials and Methods section says the study counted diabetes clinically recognized before pregnancy; it does not establish an increase in pregnant individuals with undiagnosed type 2 diabetes in early pregnancy. Page numbers are unavailable in our copy. (LLM, conf=0.89)
Experimental — accuracy not yet measured
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.
“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 [165]
The Comments report increasing pregestational type 2 diabetes and suggest that rising obesity among women of reproductive age likely contributed. But Materials and Methods says the study identified diabetes clinically recognized before pregnancy; it does not establish an increase in undiagnosed type 2 diabetes in early pregnancy. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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Pothongsangarun, K., Li, J., Naeowong, W., Apirakviriya, C., Phutrakool, P., Juntamongkol, T., Sae-chueng, T., Horpratraporn, K., Jaisamrarn, U., & Santibenchakul, S. (2024) · Figshare · doi:10.6084/m9.figshare.26626324
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TABLE 5.16, Age-Adjusted Prevalence of Pregestational Type 1 and Type 2 Diabetes in Pregnancy, by Race/Ethnicity, Northern California, 1996–2014
Kitzmiller, J. L., Ferrara, A. M., Peng, T., Cissell, M. A., & Kim, C. (2018)
Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005
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A cohort study of trends in the prevalence of pregestational diabetes in pregnancy recorded in UK general practice between 1995 and 2012
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The Increasing Prevalence of Diabetes in Pregnancy
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Prevalence and associated social determinants of health for pregestational and gestational diabetes mellitus in California by disaggregated racial and ethnic groups and subgroups
Hsieh, C.-T., Xu, X., Ren, X., Chehab, R. F., Zhu, Y., & Chen, L. (2026) · Preventive Medicine · doi:10.1016/j.ypmed.2026.108609

Authors: Peng, T. Y., Ehrlich, S. F., Crites, Y., Kitzmiller, J. L., Kuzniewicz, M. W., Hedderson, M. M., & Ferrara, A.
Affiliations: Kaiser Permanente (US)
Santa Clara Valley Medical Center (US)
Corresponding author: Ferrara, Assiamira
ORCID: Ehrlich, Samantha F.
Kuzniewicz, Michael W.
Hedderson, Monique M.
Ferrara, Assiamira
Venue: American Journal of Obstetrics and Gynecology
Publisher: Elsevier BV
Published: 2017-02
Volume: 216
Issue: 2
Pages: 177.e1-177.e8
ISSN: 0002-9378 (ISSN-L)
DOI: 10.1016/j.ajog.2016.10.007
PMC: PMC5290002
OpenAlex: W2536874336
Cited by: 94
References: 31
Citations by year: 2026: 2 · 2025: 12 · 2024: 9 · 2023: 11 · 2022: 11 · 2021: 15 · 2020: 12 · 2019: 3 · 2018: 16 · 2017: 3
FWCI: 9.47
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: American Journal of Obstetrics and Gynecology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (K01DK105106, P30DK092924)
Topics: Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: pregestational diabetes, type 1 diabetes, type 2 diabetes, diabetes prevalence trends, racial and ethnic disparities, Hispanic women, non-Hispanic white women, Northern California, perinatal outcomes, gestational diabetes screening, health equity
MeSH terms: Adult, Asian, Black or African American, California, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Ethnicity, Female, Hispanic or Latino, Humans, Obesity, Pregnancy, Pregnancy Complications, Pregnancy in Diabetics, Cohort Studies, Prevalence, Logistic Models, White People, Health Status Disparities, Young Adult

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Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996-2014

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