Research from California suggests there has been a dramatic rise in the number of teenage and adult women who develop diabetes before motherhood, with figures showing a doubling in numbers between 1999 and 2005.
The study is the work of researchers at Kaiser Permanente’s Department of Research and Evaluation in Pasadena, California. It was first published online in January this year and is about to come out in print in the May issue of Diabetes Care.
This is the first study to look at diabetes before pregnancy. Other studies have looked into the incidence of diabetes during pregnancy, called gestational diabetes, which usually disappears once the baby is born. However, having type 1 or type 2 diabetes before pregnancy is considered more dangerous than gestational diabetes.
Dr Jean M Lawrence, study lead author and research scientist at Kaiser Permanente’s Department of Research and Evaluation said:
“More young women are entering their reproductive years with diabetes, in part due to the fact that our society has become more overweight and obese.”
“While we currently don’t know how to prevent type 1 diabetes, the steps to reducing risk of type 2 diabetes must start before childbearing years: healthy eating, active living and maintaining a healthy weight. These habits should begin in childhood and continue through adulthood,” she added.
The research involved over 175,000 women who had their babies between 1999 and 2005 in 11 Kaiser Permanente hospitals in Southern California. Of these, 52 per cent were Hispanic, 26 per cent were White, 11 per cent were Asian/Pacific Islanders and 10 per cent were African-American.
The results showed:
- There were twice as many births to women with diabetes in 2005 as there were in 1999.
- Diabetes increased five-fold among 13 to 19 year-olds having babies.
- It doubled among 20 to 39 year olds giving birth.
- Among women 40 and older having babies, diabetes went up 40 per cent.
- Pre-pregnancy diabetes was more prevalent in African-American, Hispanic, and Asian/Pacific Islander women than White women.
The researchers said the study findings are particularly relevant, given that two thirds of Americans are either overweight or obese, as are nearly 15 million American children.
Diabetes before pregnancy imposes a greater risk to mother and child than diabetes that develops during pregnancy, which occurs in about 8 per cent of pregnancies.
Diabetes during pregnancy is usually triggered when insulin resistance develops in the third term, causing raised blood sugar. Gestational diabetes is often linked with larger babies, obesity in childhood and an increased risk of the mother going on to develop type 2 diabetes.
Women who are diabetic before becoming pregnant have a greater risk of miscarriage, stillbirth and having babies born with defects. This is because the of the higher risk of damage that elevated maternal blood sugar can cause on the fetus during its first three months of development, when organs are formed.
Lawrence had this advice to women thinking of having a baby and who have type 1 or type 2 diabetes:
“Work with your health care professional to get your blood sugar in good control.”
“If you are pre-diabetic or have type 2 diabetes and are overweight, work on reducing your weight by a few pounds before becoming pregnant,” she added.
She also said it was important for women who develop diabetes during pregnancy to get their blood sugar tested after they’ve had their baby, just to check it has gone back to normal.
Study co-author, Dr David Sacks, who as a Kaiser Permanente perinatologist specializing in maternal fetal medicine treats up to 50 diabetics expectant mothers a year, said that the best way to reduce the rising rate of type 2 diabetes in young women is to limit overall obesity:
“We’ve become a more sedentary and obese society so naturally type 2 diabetes has risen too.”
“For Latina women, the risk is even higher for developing type 2 diabetes, so it’s really important to defy family history and work on achieving a healthy weight,” he added.
He emphasized the importance of physicians keeping an eye on a patient’s diabetes protocol before, during and after pregnancy and said that a good records system, such as the one they have at Kaiser Permanente, helps.
“Trends in the Prevalence of Pre-Existing Diabetes and Gestational Diabetes Mellitus among a Racially/Ethnically Diverse Population of Pregnant Women, 1999-2005.”
Jean M. Lawrence, Richard Contreras, Wansu Chen, and David A. Sacks
Diabetes Care First published online on January 25, 2008, as dc07-2345
Sources: Kaiser Permanente Division of Research.
Written by: Catharine Paddock, PhD