title: Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy.
abstract: BACKGROUND
  Increasing diabetes prevalence affects a substantial number of pregnant women in the United States. Our aims were to evaluate health outcomes, medical costs, risks and types of complications associated with diabetes in pregnancy for mothers and newborns.
  
  
  METHODS
  In this retrospective claims analysis, patients were identified from the Truven Health MarketScan(®) database (2004-2011 inclusive). Participants were aged 18-45 years, with ascertainable diabetes status [Yes/No], date of birth event >2005 and continuous health plan enrolment ≥21 months before and 3 months after the birth.
  
  
  RESULTS
  In total, 839 792 pregnancies were identified, and 66 041 (7.86%) were associated with diabetes mellitus [type 1 (T1DM), 0.13%; type 2 (T2DM), 1.21%; gestational (GDM), 6.29%; and GDM progressing to T2DM (patients without prior diabetes who had a T2DM diagnosis after the birth event), 0.23%]. Relative risk (RR) of stillbirth (2.51), miscarriage (1.28) and Caesarean section (C-section) (1.77) was significantly greater with T2DM versus non-diabetes. Risk of C-section was also significantly greater for other diabetes types [RR 1.92 (T1DM); 1.37 (GDM); 1.63 (GDM progressing to T2DM)]. Risk of overall major congenital (RR ≥ 1.17), major congenital circulatory (RR ≥ 1.19) or major congenital heart (RR ≥ 1.18) complications was greater in newborns of mothers with diabetes versus without. Mothers with T2DM had significantly higher risk (RR ≥ 1.36) of anaemia, depression, hypertension, infection, migraine, or cardiac, obstetrical or respiratory complications than non-diabetes patients. Mean medical costs were higher with all diabetes types, particularly T1DM ($27 531), than non-diabetes ($14 355).
  
  
  CONCLUSIONS
  Complications and costs of healthcare were greater with diabetes, highlighting the need to optimize diabetes management in pregnancy.
authors.affiliation: Sansum Diabetes Research Institute, Santa Barbara, CA, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: Jovanovič
authors.affiliation: Novo Nordisk Inc., Plainsboro, NJ, USA.
authors.forename: Yuanjie
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Novo Nordisk Inc., Plainsboro, NJ, USA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Weng
authors.affiliation: Novo Nordisk Inc., Plainsboro, NJ, USA.
authors.forename: Marianthe
authors.initials: M
authors.lastname: Hamilton
authors.affiliation: Novo Nordisk Inc., Plainsboro, NJ, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Chen
authors.affiliation: Novo Nordisk Inc., Plainsboro, NJ, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Wintfeld
mesh_terms: D000022:Abortion, Spontaneous / Q000191:economics / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000191:economics / Q000453:epidemiology; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data; D000013:Congenital Abnormalities / Q000191:economics / Q000453:epidemiology*; D003863:Depression / Q000191:economics / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000191:economics / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs; D006330:Heart Defects, Congenital / Q000191:economics / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000191:economics / Q000453:epidemiology; D011250:Pregnancy Complications, Hematologic / Q000191:economics / Q000453:epidemiology; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000191:economics / Q000453:epidemiology*; D011254:Pregnancy in Diabetics / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D050497:Stillbirth / Q000191:economics / Q000453:epidemiology; D014481:United States; D055815:Young Adult
keywords: cost-effectiveness; diabetes complications; gestational diabetes; pregnancy; type 1 diabetes; type 2 diabetes