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Pre-gestational Versus Gestational Diabetes in the U.S.

Asian population has the highest prevalence of GDM in a California study…. 

In the United States, approximately 6-7% of pregnancies are affected by diabetes. Of these, about 85% are due to gestational diabetes mellitus (GDM), with the remainder attributable to pre-gestational diabetes mellitus (PGDM). While PGDM includes both type 1 and 2 diabetes occurring prior to pregnancy, GDM refers to glucose intolerance with an onset during pregnancy.

Previous research has reported complications associated with both PGDM and GDM, including neonatal hypoglycemia, perinatal mortality, and increased cesarean delivery risk. This retrospective study set out to determine clinical differences between patients with PGDM and GDM in the state of California.

Researchers utilized data from inpatient California discharge data delivery ICD-9 codes during the years 2001-2007 for both PGDM and GDM. Comparisons between the two groups were made and analyzed statistically. An increasing incidence for both PGDM and GDM was found during the time period studied. Researchers also found certain factors to be associated with increased prevalence of both diseases. These factors included increased maternal age, and Asian ethnicity. While Asians were found to have the highest prevalence of GDM, both Asians and Caucasians were found to have the lowest prevalence of PGDM, as compared to other races.

The authors identified certain health conditions that appeared more frequently among those with PGDM versus GDM. These conditions included hypertension, renal disease, thyroid disease, pyelonephritis, fetal CNS malformation, and eclampsia. In addition, it was found that mothers with PGDM were more likely to have a cesarean delivery as compared to those mothers with GDM.

The authors concluded that clinical findings vary between patients with PGDM and GDM, with PGDM having significantly higher morbidity. Interestingly, the authors report that patients likely to have GDM during pregnancy are likely not those same persons with the highest tendencies for PGDM outside of pregnancy.

Practice Pearls:

  • Both PGDM and GDM have increased in prevalence in the state of California, and thus likely the US as a whole, during the years 2001-2007.
  • Mothers with PGDM were more likely to have a cesarean delivery as compared to those mothers with GDM.
  • Clinical findings vary between patients with PGDM and GDM, with PGDM having significantly higher morbidity.

Diabetes/Metabolism Research & Reviews 2014. [Fong, A. et al. Pre-gestational versus gestational diabetes: A population based study on clinical and demographic differences. Journal of Diabetes and Its Complications. 2014;28:29-34]