1. Diabetes in Pregnancy Burden of Disease

2. Diabetes in Pregnancy: Epidemiology 2%-10% of pregnancies currently are complicated by gestational diabetes mellitus (GDM) New diagnostic criteria estimated to increase rate to 18% 2,3,4 The prevalence of both GDM and type 2 diabetes mellitus have increased as obesity and sedentary lifestyle have increased in the United States 5 Pregnancies complicated by preexisting diabetes have increased substantially; most likely due to increased prevalence of T2DM in younger patients 6,7 1. Engelgau, MM, et al. Diabetes Care. 1995;18(7):1029-33. 2. CDC. National Diabetes Fact Sheet 2011. CDC. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 2011. Accessed: April 26, 2012. 3. ADA. What is Gestational Diabetes? ADA. http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html.2010. Accessed: April 26, 2012. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf 4. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66. 5. Chitayat L, et al. Diabetes Technol Ther. 2009;11:S105-111. 6. Pinhas-Hamiel O, Zeitler P. Pediatric Diabetes. 2007;8(9):16-27. 7. National Diabetes Education Program. Overview of Diabetes in Children and Adolescents. NIH. http://ndep.nih.gov/media/Youth_factsheet.pdf. June 2011. Accessed: April 26, 2012.http://ndep.nih.gov/media/Youth_factsheet.pdf

3. Risks Associated With Diabetes in Pregnancy Maternal RisksFetal Risks Preeclampsia 1 Increased caesarean delivery 1 Subsequent development of T2DM 1 30% maternal mortality rate 2 Progression of chronic complications of diabetes 4 Gestational hypertension 5 Hypoglycemia 1 Infection (eg, pyelonephritis) 6,7 Ketoacidosis 6,7 Polyhydramnios 6,7 Preterm labor 6,7 Seizures 4,6 Doubled spontaneous abortion risk 4 Maternal birth weight <4 lbs 7 oz 9 Birth injuries 1,7 Childhood obesity 1,7 Hyperbilirubinemi 1,7 Hypoglycemia 1,7 Macrosomia 1,7 Shoulder dystocia 1,7 Respiratory distress syndrome 1,7 Premature birth 1,7 Increased cord-blood serum C-peptide levels 1,7 Abnormal birth weight (low or high) 4 Increased risk of T2DM and/or GDM later in life 8 Increased congenital malformations 4 Morbidity and Mortality 1. Committee on Obstetric Practice. ACOG. 2011;504:1-3. 2. Jovanovic L. Insulin therapy in pregnancy. In: Leahy JL, Cefalu WT, eds. Insulin Therapy. New York, NY: Marcel Dekker Inc; 2002:139-151. 3. Jovanovic L, Peterson CM. Diabetes Care. 1982;5(1):24-37. 4. AACE. Endocr Pract. 2011;17(2):1-53. 5. Metzger BE, et al. Diabetes Care, 2007;30(2):S251- 60. 6. Jovanovic L, et al. Mt Sinai J Med. 2009;76(3):269-80. 7. Castorino K et al. Curr Diab Rep, 2012;12:53-59. 8. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66. 9. Inness KE, et al. JAMA. 2002;287(19):2534-41.

4. GDM: Pathophysiology Gestational diabetes mellitus (GDM) Combination of: Glucose intolerance Hyperglycemia Beta-cell dysfunction 2 Insulin resistance due to placental secretion of anti- insulin hormones 1 Late pregnancy: Maternal hepatic glucose production increases by 15%-30% to meet fetal demand 1 Pancreatic beta- cell dysfunction caused by: Genetics Autoimmune disorders Chronic insulin resistance 1,2 1.Inturrisi M, et al. Endocrinol Metab Clin N Am. 2011;40:703-26. 2. Metzger BE, et al. Diabetes Care. 2007;30(2):S251- 60.

5. GDM: Etiology and Risk Factors Hormonally induced insulin resistance Resulting in hyperglycemia Eventually progresses into diabetes Etiology Obesity Previous history of GDM Prior delivery of a large baby (>9 lbs) Glycosuria Family history of diabetes in a first-degree relative Gestational diabetes mellitus (GDM) risk factors 1,2 5%-10% of women with GDM develop T2DM immediately postpartum 6 35%-60% chance of T2DM over next 10-20 years 6 Risk increased with uncontrolled blood sugar in pregnancy 5 Risk of future T2DM 1. American Diabetes Association. Diabetes Care. 2004;27(1):S88-S90. 2. ADA. Diabetes Care. 2013;36(suppl 1):S11-S66. 3. Inturrisi M, et al. Endocrinol Metab Clin N Am. 2011;40:703-26. 4. Metzger BE, et al. Diabetes Care. 2007;30(2):S251- 60. 5. Committee on Obstetric Practice. ACOG. 2011;504:1-3. 6. CDC. National Diabetes Fact Sheet 2011. CDC. Http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 2011. Accessed: April 26, 2012. Http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

6. 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 1. Werner EF, et al. Diabetes Care. 2012;35:529-35.