title: Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes.
abstract: OBJECTIVE
  To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service.
  
  
  METHODS
  Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes.
  
  
  RESULTS
  Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups.
  
  
  CONCLUSIONS
  The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Centre, Gachon University, Incheon, Korea.
authors.forename: K H
authors.initials: KH
authors.lastname: Son
authors.forename: N-K
authors.initials: NK
authors.lastname: Lim
authors.forename: J-W
authors.initials: JW
authors.lastname: Lee
authors.forename: M-C
authors.initials: MC
authors.lastname: Cho
authors.forename: H-Y
authors.initials: HY
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000191:economics* / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000150:complications / Q000191:economics*; D016640:Diabetes, Gestational / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000191:economics*; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000191:economics; D056910:Republic of Korea; D055815:Young Adult