Diabetes during pregnancy raises the risk of harm to both mother and baby. Preexisting diabetes — type 1 or type 2 diagnosed before pregnancy — raises a baby's risk of birth defects, stillbirth and being large for gestational age. Gestational diabetes, which develops and is diagnosed in the second half of pregnancy, raises the risk of a large-for-gestational-age baby, might raise the child's risk of obesity, and raises the mother's own risk of type 2 diabetes later.
Both became more common in the United States between 2000 and 2010, but recent state trends had not been reported, so CDC analyzed 2012–2016 birth data from the National Vital Statistics System.
How it was measured
The U.S. Standard Certificate of Live Birth, revised in 2003, has separate boxes for preexisting and gestational diabetes; the National Center for Health Statistics recommends filling them from prenatal records, labor and delivery forms or delivery records. Forty jurisdictions used the revised certificate by 2012, covering 86.3% of live births to U.S. residents, and all did by January 2016.
- 2016 national figures cover all U.S. resident mothers with a live birth that year (3,942,094 women).
- Trends use the 40 jurisdictions with data for every year from 2012 to 2016 — 17,050,514 women, 86% of U.S. resident women giving birth in that period — standardized to the 2012 mix of mothers' ages and race/ethnicity, since both vary by place and drive diabetes risk.
Who had diabetes in pregnancy, 2016
Nationally, 0.9% of women giving birth had preexisting diabetes and 6.0% had gestational diabetes. Both differed significantly by every characteristic examined.
| Group | Preexisting | Gestational |
|---|---|---|
| Under 20 | 0.4% | 1.9% |
| 30–34 | 1.0% | 7.0% |
| 40 and older | 2.1% | 12.8% |
| White, non-Hispanic | 0.7% | 5.3% |
| Black, non-Hispanic | 1.2% | 4.8% |
| Asian, non-Hispanic | 0.9% | 11.1% |
| Hispanic | 1.0% | 6.6% |
| American Indian/Alaska Native | 2.1% | 9.2% |
| Native Hawaiian/Pacific Islander | 1.8% | 8.4% |
| Born outside the U.S. | 0.9% | 8.4% |
| Underweight before pregnancy | 0.3% | 2.9% |
| Normal weight | 0.4% | 3.6% |
| Obesity class I | 1.3% | 8.8% |
| Obesity class III | 3.2% | 13.9% |
Gestational diabetes was highest among Asian women, in line with earlier research; preexisting diabetes was highest among American Indian/Alaska Native and Native Hawaiian/Pacific Islander women.
Standardized prevalence of preexisting (A) and gestational (B) diabetes among women with a live birth, by state, 2016. CDC.
By state, and over time
After standardizing, preexisting diabetes in 2016 ranged from 0.5% in California to 1.7% in West Virginia, and gestational diabetes from 3.4% in the District of Columbia to 9.2% in South Dakota.
Across the 40 jurisdictions with continuous data:
| 2012 | 2016 | Change by jurisdiction | |
|---|---|---|---|
| Preexisting diabetes | 0.8% | 0.8% | Significant rises in eight, from 0.1 point (California) to 0.3 (Georgia); a significant fall only in Oklahoma (0.4 point) |
| Gestational diabetes | 5.2% | 5.6% | Significant rises in many, the largest 3.2 points in South Dakota; significant falls in six, from 0.4 point (Massachusetts) to 1.9 (New Hampshire) |
Earlier studies of hospital discharges in 19 states found preexisting diabetes rising from 0.7% to 0.9% and gestational diabetes from 3.7% to 5.8% between 2000 and 2010. The authors suggest the rises may partly reflect more obesity before pregnancy, and that preexisting diabetes may now be leveling off.
Chances to act
- Before pregnancy: preconception care can reinforce diabetes management for women with type 1 or type 2 diabetes, and better blood sugar control before the fetus's critical early development might reduce harm. Because overweight and obesity before pregnancy are strongly tied to gestational diabetes, it is also a chance to screen BMI and refer women with obesity to intensive behavioral programs.
- During pregnancy: lifestyle interventions in the first half of pregnancy might lower the risk of gestational diabetes, though which designs work best needs more research.
- After birth: gestational diabetes strongly predicts type 2 diabetes. Women who had it are advised to be tested 4–12 weeks after delivery, referred for care if diabetes is found, and monitored for life if not; some studies show testing falls short. Programs such as those recognized through CDC's National Diabetes Prevention Program lower type 2 risk in high-risk adults, and after gestational diabetes, postpartum lifestyle programs have reduced retained weight and improved markers of insulin resistance — though new mothers face barriers such as childcare and lack of time.
Limits
- Birth certificates may undercount both conditions, differently by place, and only live births were included; studies put their sensitivity at 47%–52% for preexisting and 46%–83% for gestational diabetes.
- Screening recommendations for gestational diabetes changed in 2014, and diagnosis varies by practice, so differences may reflect testing rather than disease.
- Trends cover only the 40 jurisdictions with data, and a difference between two years does not mean steady change in between.
- With samples this large, some significant differences may not be meaningful.
Sources
Based on Deputy NP, Kim SY, Conrey EJ, Bullard KM, "Prevalence and Changes in Preexisting Diabetes and Gestational Diabetes Among Women Who Had a Live Birth — United States, 2012–2016," MMWR Vol. 67, No. 43, CDC; a work of the United States government in the public domain. The report's text calls preexisting diabetes across the 40 jurisdictions stable, changing by under 0.1 point, while its table marks a statistically significant 0.1-point difference; and its text counts 22 jurisdictions with significant rises in gestational diabetes, starting from Illinois, while its table does not mark Illinois's change as significant. Neither version is given here.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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