Diabetes in pregnancy: rising prevalence presents challenges for maternity services
Mackintosh and colleagues report that more than a quarter of
pregnancies complicated by diabetes in the UK now occur in women with type
2 diabetes (1), and rates of type 2 diabetes in young women are
anticipated to rise. Macfarlane and Tuffnell note the paucity of data on
changing prevalence of type 2 diabetes in pregnancy (2).
We have maintained a continuous population based survey of
pregnancies in women with pre-existing diabetes, and a review of nine
years’ experience, including nearly 1200 pregnancies delivered between
1996 and 2004, has recently been completed (3). Over this period, the
prevalence of births complicated by maternal diabetes (types 1 and 2)
increased by around 50%, from 3.1 per 1000 total births in 1996-98 to 4.7
per 1000 births in 2002-04. When fetal losses and terminations of
pregnancy are included, the increase is slightly less at around one third,
from 4.0 per 1000 births in 1996-98 to 5.3 per 1000 in 2002-04. The
difference reflects a reduction in fetal losses.
The proportion of pregnancies to women with type 2 diabetes increased
from 7% in 1996-98 to 10% in 1997-99, and then sharply to 26% in 2002-04,
reaching a rate similar to that reported by Macintosh and colleagues. The
prevalence of maternal type 2 diabetes (including fetal losses,
terminations and births) increased more than four fold, from 0.3 per 1000
births to 1.4 per 1000 births. There was little change in the prevalence
of maternal type 1 diabetes – 3.7 per 1000 births in 1996-98 and 3.9 per
1000 in 2002-04. Thus the increase in pregnancies complicated by diabetes
in our region between 1996 and 2004 was almost entirely due to women with
type 2 diabetes.
Rising obesity in young women is likely to be the main underlying
factor, in a region with a relatively low prevalence of Asian or Black
ethnicity. Obesity is also a major factor in gestational diabetes, and
with the recent publication of evidence that intervention improves
outcomes in this group of women (4), maternity services are likely to
experience a sharp rise in the numbers of women with diabetes in pregnancy
requiring intensive surveillance. The challenge is to maintain and
improve standards of care, and pregnancy outcomes, in the context of these
increasing demands. Attention also needs to be directed towards
implementing effective strategies for reducing obesity in young women.
1. Macintosh M, Fleming K, Bailey J, 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;333:177-80.
2. Macfarlane A, Tuffnell D. Diabetes and pregnancy. British Medical
3. Bailey K, Lewis-Barned N. Northern Diabetes in Pregnancy Survey -
audit of units against standards of care. Occasional Paper No 19: North
East Public Health Observatory, 2005.
4. Crowther C, Hiller J, Moss J, McPhee A, Jeffries W, Robinson J.
Effect of treatment of gestational diabetes mellitus on pregnancy
outcomes. New England Journal of Medicine 2005;352:2477-2468.
Competing interests: No competing interests