Burden of Diabetes in Pregnancy

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Presentation transcript:

Burden of Diabetes in Pregnancy

Diabetes in Pregnancy Is Increasing Single-State Retrospective Study*1 (N=209,287 screened pregnancies) 19-State Retrospective Study†2 37% increase (P<0.01) Rate per 100 births Rate per 100 births *Kaiser Permanente Hospitals, Southern California. †AHRQ inpatient database, 19 U.S. states. AHRQ, Agency for Healthcare Research and Quality; GDM, gestational diabetes mellitus; T1D, type 1 diabetes; T2D, type 2 diabetes. 1. Lawrence JM, et al. Diabetes Care. 2008;31:899-904. 2. Bardenheier BH, et al. Am J Prev Med. 2015;48:154-161.

Pregnancy Complicated by Pre-existing Diabetes, But Not GDM, Is Rising Kaiser-Permanente Study (N=175,249*) Pregnant Women With Pre-existing Diabetes Women With Gestational Diabetes Prevalence per 100 births *Women with 209,287 singleton deliveries of 20 weeks’ gestation. Lawrence JM, et al. Diabetes Care. 2008;31:899-904.

Risks Associated With Diabetes in Pregnancy Maternal Risks Fetal Risks Preeclampsia Increased caesarean delivery Subsequent development of T2D 30% maternal mortality rate Progression of chronic complications of diabetes Gestational hypertension Hypoglycemia Infection (eg, pyelonephritis) Ketoacidosis Polyhydramnios Preterm labor Seizures Doubled spontaneous abortion risk Maternal birth weight <4 lb 7 oz Birth injuries Childhood obesity Hyperbilirubinemia Macrosomia Shoulder dystocia Respiratory distress syndrome Premature birth Increased cord-blood serum C-peptide levels Abnormal birth weight (low or high) Increased risk of T2D and/or GDM later in life Increased congenital malformations GDM, gestational diabetes mellitus; T2D, type 2 diabetes. Committee on Obstetric Practice. ACOG. 2011;504:1-3. Jovanovic L. Insulin therapy in pregnancy. In: Leahy JL, Cefalu WT, eds. Insulin Therapy. New York, NY: Marcel Dekker Inc; 2002:139-151. Jovanovic L, Peterson CM. Diabetes Care. 1982;5:24-37. Handelsman YH, et al. Endocr Pract. 2015;21(suppl 1):1-87. Metzger BE, et al. Diabetes Care. 2007;30:S251-S60. Jovanovic L, et al. Mt Sinai J Med. 2009;76:269-280. Castorino K et al. Curr Diabetes Rep. 2012;12:53-59. 8. ADA. Diabetes Care. 2015;38(suppl 1):S77-S79. Inness KE, et al. JAMA. 2002;287:2534-2541.

Pathophysiology of Gestational Diabetes Mellitus Insulin resistance due to placental secretion of anti-insulin hormones Maternal hepatic glucose production increases by 15%-30% to meet fetal demand late in pregnancy Pancreatic -cell dysfunction due to Genetics Autoimmune disorders Chronic insulin resistance Inturrisi M, et al. Endocrinol Metab Clin N Am. 2011;40:703-726. Metzger BE, et al. Diabetes Care. 2007;30(2):S251-S260.

GDM: Etiology and Risk Factors Hormonally induced insulin resistance Leads to impaired glucose tolerance Eventually progresses to diabetes Etiology Obesity Previous history of GDM Prior delivery of a large baby (>9 lbs) Glycosuria History of diabetes in a first-degree relative Risk factors 5%-10% of women with GDM develop T2D immediately postpartum 35%-60% chance of T2D over next 10-20 years Risk of future T2D ADA. Diabetes Care. 2017;40(suppl 1):S114-S119. Inturrisi M, et al. Endocrinol Metab Clin N Am. 2011;40:703-26. Metzger BE, et al. Diabetes Care. 2007;30:S251-S60. Committee on Obstetric Practice. ACOG. 2011;504:1-3. CDC. National Diabetes Fact Sheet 2011. CDC. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 2011.

Cost-Effectiveness of New Screening Criteria International Association of the Diabetes and Pregnancy Study Groups (IADPSG) has proposed new screening criteria for gestational diabetes mellitus (GDM) For every 100,000 women screened under the updated criteria, 6,178 quality-adjusted life-years (QALYs) will be gained at a cost of approximately $126 million Compared with current GDM screening practices, the new IADPSG strategy has an incremental cost-effectiveness ratio (ICER) of $20,336 per QALY gained Werner EF, et al. Diabetes Care. 2012;35:529-535.