Diabetes during pregnancy in any form, whether pregestational (type 1 or type 2) or gestational, increases the risk for adverse maternal and infant outcomes and impacts developmentally on the same systems (see Schaefer-Graf etal., 2000)
In the USA for the year 2000 the most frequently reported medical risk factors were: pregnancy-associated hypertension (38.8 per 1,000 live births) and diabetes (29.3) follwed by anemia (23.9).
A tenfold increase in the prevalence of hypertension and a 10 percent incidence of gestational diabetes have been reported in obese pregnant women.
Human embryonic pancreas (Stage 22)
Note that in some countries reporting on diabetes on birth certificates has a field that indicates whether the "mother had diabetes during pregnancy", but does not necessarily whether this was gestational or a pre-existing diabetes.
Page Links: Introduction | Some Recent Findings | Gestational Diabetes | Gestational Diabetes Statistics | Australian NHMRC Recommendations | WWW Links | References | Glossary
Macfarlane A, Tuffnell D. Diabetes and pregnancy. BMJ. 2006 Jul 22;333(7560):157-8. "The evidence that rates of type 2 diabetes in pregnancy are rising is largely based on global figures1 and individual clinicians' reports of younger pregnant women with the condition.2 Until recently, care for women with diabetes in pregnancy has focused on type 1 diabetes. A paper in this week's BMJ finds that high rates of congenital anomalies, stillbirth, and neonatal death were reported in women with type 2 diabetes as well as those with type 1 diabetes."
A recent UK study on the effects of maternal diabetes on development showed "Perinatal mortality and prevalence of congenital anomalies are high in the babies of women with type 1 or type 2 diabetes. The rates do not seem to differ between the two types of diabetes." Macintosh MC, Fleming KM, Bailey JA, Doyle P, Modder J, Acolet D, Golightly S, Miller A. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ. 2006 Jun 16;
Schaefer-Graf UM, Buchanan TA, Xiang A, Songster G, Montoro M, Kjos SL. Patterns of congenital anomalies and relationship to initial maternal fasting glucose levels in pregnancies complicated by type 2 and gestational diabetes. Am J Obstet Gynecol. 2000 Feb;182(2):313-20. "Congenital anomalies in offspring of women with gestational and type 2 diabetes affect the same organ systems that have been previously described in pregnancies complicated by type 1 diabetes. Increasing hyperglycemia at diagnosis or presentation for care was associated with an increasing risk of anomalies in general and with anomalies involving multiple organ systems without a preferential increase in involvement of specific organ system." Endocrine Notes - Pancreas | Endocrine Notes - Maternal diabetes mellitus
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with the onset or first detection during pregnancy.
Women with gestational diabetes mellitus can progress to type 2 diabetes mellitus (progression rate 6% to 92%).
Well-controlled class A1 gestational diabetes (fasting blood sugar less than 105 mg/dL). Recent study shows no evidence clearly supports the practice of increased fetal surveillance in these pregnancies.
| Blood glucose targets for most women with gestational diabetes |
||
|
|
On awakening |
not above 95 |
| 1 hour after a meal |
not above 140 |
|
| 2 hours after a meal |
not above 120 |
|
(Data: NIDDK (NIH) - Gestational Diabetes)
Links: HSTAT: Guide to Clinical Preventive Services, 3rd Edition: Recommendations and Systematic Evidence Reviews, Guide to Community Preventive Services Screening for Gestational Diabetes Mellitus | American Diabetes Association - Gestational Diabetes Resource Guide | Medline Plus - Gestational Diabetes | National Institute of Diabetes and Digestive and Kidney Diseases (NIH) - Gestational Diabetes | NIHCD - Am I at Risk for Gestational Diabetes? PDF Document | Health Insite (Aus) Pregnancy Complications | American Diabetes Association Diabetes and Pregnancy and Gestational Diabetes
Fetal macrosomia is a clinical description for a fetus that is too large, condition increases steadily with advancing gestational age and defined by a variety of birthweights. In pregnant women, anywhere between 2 - 15% have birth weights of greater than 4000 grams (4 Kg, 8 lb 13 oz). (More? Birth)
Australian Data
Gestational diabetes (GDM) in Victoria 1971-1991 - singleton pregnancies (5.6%) and twin pregnancies (7.4%, p = 0.025).
GDM in 1971-1980 singleton and twin pregnancies were 3.0% and 5.6% respectively (p = 0.012)
GDM in 1981-1991 singleton and twin pregnancies were 7.4% and 8.4% (p = 0.36)
The difference in prevalence of GDM in twin and singleton pregnancies is less now that the overall prevalence of the disease has more than doubled (1971-1980 versus 1981-1991). The increased rate of permanent diabetes mellitus after twin pregnancy is not statistically significant.
Data: Wein P, Warwick MM, Beischer NA. Gestational diabetes in twin pregnancy: prevalence and long-term implications. Aust N Z J Obstet Gynaecol. 1992 Nov;32(4):325-7.
Australian Aboriginal - The age-standardized GDM rate for Aboriginal mothers (South Australia between 1988 and 1999) was found to be more than 2.5 times higher than that for non-Aboriginal mothers
Data: Ishak M, Petocz P. Gestational diabetes among Aboriginal Australians: prevalence, time trend, and comparisons with non-Aboriginal Australians. Ethn Dis. 2003 Winter;13(1):55-60.
Bower C, Stanley F, Connell AF, Gent CR, Massey MS. Birth defects in the infants of aboriginal and non-aboriginal mothers with diabetes in Western Australia. Med J Aust. 1992 Apr 20;156(8):520-4.
USA
GDM in 1999 - 2005 - 199,298 screened was identified in 15,121 (7.6%) pregnancies. Among all deliveries to women with either form of diabetes, 10% were due to pre-existing diabetes in 1999, rising to 21% in 2005, with GDM accounting for the remainder.
Data: Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the Prevalence of Pre-Existing Diabetes and Gestational Diabetes Mellitus among a Racially/Ethnically Diverse Population of Pregnant Women, 1999-2005. Diabetes Care. 2008 Jan 25
Australaian References
Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in South Australia 1986-2000: a population-based cohort study. Birth Defects Res A Clin Mol Teratol. 2005 Sep;73(9):605-11.
The Australasian Diabetes in Pregnancy Society ADIPS Consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy (2005)
Medical Journal of Australia - Consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy (2005))
Centers for Disease Control and Prevention (CDC, USA): Health Topic: Diabetes | The Prevention and Treatment of Complications of Diabetes Mellitus A Guide for Primary Care Practitioners (1998) | Diabetes During Pregnancy -- United States, 1993-1995 |
Confidential Enquiry into Maternal and Child Health (UK): CEMACH | births to women with type 2 diabetes
The Australian NHMRC (1988) recommends neonates be assessed for follow-up care under the following conditions.
(see the NHMRC WWW Page)
Links: Reviews | Articles | Online Textbooks | Search Textbooks | Search PubMed | Glossary
Loomis L, Lee J, Tweed E, Fashner J. What is appropriate fetal surveillance for women with diet-controlled gestational diabetes? J Fam Pract. 2006 Mar;55(3):238-40.
Lucas MJ. Diabetes complicating pregnancy. Obstet Gynecol Clin North Am. 2001 Sep;28(3):513-36. Review.
Bird S. Failure to diagnose: gestational diabetes. Aust Fam Physician. 2006 Jun;35(6):437-8.
Cho HJ, Shin JS, Yang JH, Ryu HM, Kim MY, Han JY, Kim JO, Ahn HK, Choi JS, Chung JH, Park SH, Kim MH, Choi KH. Perinatal outcome in twin pregnancies complicated by gestational diabetes mellitus: a comparative study. J Korean Med Sci. 2006 Jun;21(3):457-9.
Ornoy A. Growth and neurodevelopmental outcome of children born to mothers with pregestational and gestational diabetes. Pediatr Endocrinol Rev. 2005 Dec;3(2):104-13.
Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in South Australia 1986-2000: a population-based cohort study. Birth Defects Res A Clin Mol Teratol. 2005 Sep;73(9):605-11.
Sheffield JS, Butler-Koster EL, Casey BM, McIntire DD, Leveno KJ. Maternal diabetes mellitus and infant malformations. Obstet Gynecol. 2002 Nov;100(5 Pt 1):925-30.
Schaefer-Graf UM, Buchanan TA, Xiang A, Songster G, Montoro M, Kjos SL. Patterns of congenital anomalies and relationship to initial maternal fasting glucose levels in pregnancies complicated by type 2 and gestational diabetes. Am J Obstet Gynecol. 2000 Feb;182(2):313-20.
Schaefer UM, Songster G, Xiang A, Berkowitz K, Buchanan TA, Kjos SL. Congenital malformations in offspring of women with hyperglycemia first detected during pregnancy. Am J Obstet Gynecol. 1997 Nov;177(5):1165-71.
Johnson SR, Kolberg BH, Varner MW, Railsback LD. Maternal obesity and pregnancy. Surg Gynecol Obstet. 1987 May;164(5):431-7.
Search Textbooks
Search NCBI Bookshelf: maternal diabetes
Search PubMed
Search Jan2006 "maternal diabetes" 5,295 reference articles of which 824 were reviews.
Search PubMed: term = maternal diabetes | gestational diabetes | pregnancy and diabetes |
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Risk Factors Present Before Pregnancy
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see also Normal Childhood Development
You should look at normal development of teh effected systems in the embryo. Development Notes
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This pages covers issues related to maternal diabetes during pregnancy, both preexisting and gestational diabetes.
For more information see the 2005 Australasian Diabetes in Pregnancy Society Consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy .
Please email Dr Mark Hill if you wish to make a comment about this current project.