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Diabetes Before and During Pregnancy a Growing Problem

Sep 28, 2012
The rates of both pre-pregnancy and gestational diabetes have increased since 1980, with greater increases in pre-pregnancy diabetes among black women…. 

According to Kelly Hunt, PhD, of the Medical University of South Carolina in Charleston, from 1980 to 2008, the estimated rate of diabetes during pregnancy — combining both gestational and pre-pregnancy diabetes — increased from 5% to 8.7% among white women and from 5.7% to 9.7% among black women.

The higher rates among black women were related to pre-pregnancy and not gestational diabetes, and the between-race gap appeared to widen over time. Hunt added that diabetes rates overall increased because of the obesity epidemic and the rising age at which women are giving birth.


"One thing that’s good is that the awareness of diabetes during pregnancy has increased a lot in the past 20 years, which is important because you want either pre-pregnancy diabetes or gestational diabetes to be treated during pregnancy so that the impact on the infant is minimized," Hunt said, noting that exposure to diabetes during pregnancy has been associated with birth defects, higher birth weight, and greater risks of childhood and adult obesity in the offspring.

She added, "More interventions are needed, both to reduce the prevalence of diabetes prior to pregnancy and to prevent women who have gestational diabetes from subsequently developing type 2 diabetes." "So I would say the take-home message is that we have a lot more work to do and with the obesity and diabetes epidemics, we really need to be thinking about how they’re impacting the next generation."

Hunt and her colleagues looked at trends in diabetes during pregnancy in non-Hispanic white and black women ages 15 to 44. They first used a regression model to estimates the risk as a function of age, race or ethnicity, and body mass index using data from South Carolina singleton births from 2004 to 2008.

That information was then merged with data from U.S. census and natality records and the National Health and Nutrition Examination Survey, then applied to a simulated population to estimate diabetes rates on the U.S. population level from 1980 to 2008.

The estimated rates of pre-pregnancy diabetes and gestational diabetes increased over time in both white and black women.

From 1980 to 2008, the rate of gestational diabetes increased from 4.09% to 6.92% among white women and from 3.98% to 6.58% among black women. The rates remained relatively similar between the races over time, with a slightly lower rate among black women.

During the same time period, the rate of pre-pregnancy diabetes increased from 0.95% to 1.81% among white women and from 1.66% to 3.17% among black women. There was a consistently higher rate among black women, with the gap widening from about 0.7% in 1980 to about 1.4% in 2008.

Practice Pearls:
  • Note that it was difficult to explain the increasing disparity because her group did not have information on how well the women were treated for either disease, but said that it could be related to disease control during pregnancy.
  • Note that the model used in this study suggests that rates of both pre-pregnancy and gestational diabetes have increased substantially since 1980, with greater increases in pre-pregnancy diabetes among black women.

Hunt K, et al "Prevalence estimates of diabetes during pregnancy in United States women, 1980 to 2008" Obesity Society 2012; Abstract 744-P.