Diabetes before motherhood more than doubled in six years among teenage and adult women, according to a Kaiser Permanente study published in the May issue of Diabetes Care.

While previous studies have looked exclusively at gestational diabetes (diabetes that develops during pregnancy, then usually disappears after the baby is born), this is the largest and most diverse study to examine pre-pregnancy type 1 and type 2 diabetes, which is more dangerous than gestational diabetes and potentially harder to treat, as well as gestational diabetes.

Researchers at Kaiser Permanente’s Department of Research & Evaluation in Pasadena looked at 175,249 women who gave birth in 11 Kaiser Permanente hospitals in Southern California between 1999 and 2005. Researchers found that there were twice as many births to women with diabetes in 2005 as there were in 1999. Fifty-two percent of the women in the study were Hispanic, 26 percent were White, 11 percent were Asian/Pacific Islanders and 10 percent were African-American.

This study found significant jumps in pre-pregnancy diabetes in every age, racial and ethnic group:
- Diabetes increased fivefold among 13- to 19-year-olds giving birth
- Diabetes doubled among women 20- and 39-year-olds giving birth
- Diabetes increased by 40 percent among women 40 and older giving birth
- African-American, Hispanic, and Asian/Pacific Islander women were more likely to have diabetes before pregnancy than White women.

“More young women are entering their reproductive years with diabetes, in part due to the fact that our society has become more overweight and obese,” said lead author Jean M. Lawrence, ScD, MPH, MSSA, a research scientist at Kaiser Permanente’s Department of Research & Evaluation. “While we currently don’t know how to prevent type 1 diabetes, the steps to reducing risk of type 2 diabetes must start before childbearing years: healthy eating, active living and maintaining a healthy weight. These habits should begin in childhood and continue through adulthood.”

Given that two-thirds of Americans are overweight or obese, and nearly 15 million children are overweight or obese, these study findings are especially relevant.

The health risks of having diabetes before becoming pregnant are greater to mother and baby than gestational diabetes, which occurs in 8 percent of pregnancies. Gestational diabetes occurs when pregnancy triggers insulin resistance in the second trimester and raises a woman’s blood glucose level and is associated with larger babies, childhood obesity, and increased maternal risk of developing type 2 diabetes. Women with pre-existing diabetes are more likely to have miscarriages, stillbirths, and babies with birth defects because they may have elevated blood sugar during the critical first trimester of pregnancy when the infants’ organs are developing.

“My advice to women who have type 1 or type 2 diabetes and are thinking about becoming pregnant is: work with your health care professional to get your blood sugar in good control. If you are pre-diabetic or have type 2 diabetes and are overweight, work on reducing your weight by a few pounds before becoming pregnant,” Lawrence said. “And women with gestational diabetes should have their blood sugar level tested after they’ve given birth to make sure it returns to normal.”

Limiting obesity is the best way to reduce the rising incidence of type 2 diabetes in young women, says study co-author David Sacks, MD, a Kaiser Permanente perinatologist who specializes in maternal fetal medicine and treats up to 50 diabetic moms-to-be a year. “We’ve become a more sedentary and obese society so naturally type 2 diabetes has risen too. For Latina women, the risk is even higher for developing type 2 diabetes, so it’s really important to defy family history and work on achieving a healthy weight.”

Sacks said Kaiser Permanente’s electronic health record, Kaiser Permanente HealthConnect™, makes it easier for physicians to monitor and treat their patients’ diabetes.

“KP HealthConnect™ gives me an immediate record of my patient’s pre-pregnancy performance, and how compliant she has been with her diabetes protocol and follow-up,” Sacks said.

Funded by a grant from the American Diabetes Association, the study was able to examine both pre-gestational diabetes and gestational diabetes in a large multi-cultural group of teenagers and adult women by using the computerized clinical and laboratory databases of Kaiser Permanente, the nation’s largest integrated health plan.

About Kaiser Permanente’s Department of Research & Evaluation
The Department of Research & Evaluation, located in Pasadena California, conducts high quality, innovative research that benefits the health of its members as well as in the general population. Fourteen full-time doctorally trained researchers conduct research in the areas of childhood and adult diabetes, cancer, chronic kidney disease, cardiovascular disease, aging and cognition, pregnancy outcomes, and women’s health and are trained in epidemiology, health services research, behavioral and social sciences, and clinical medicine. Kaiser Permanente also has an active clinical trials program.

About Kaiser Permanente Research
Kaiser Permanente’s eight research centers comprise one of the largest research programs in the United States and engage in work designed to improve the health of individuals everywhere. KP HealthConnect™ , Kaiser Permanente’s electronic health record, and other resources provide population data for research, and in turn, research findings are fed into KP HealthConnect™ to arm physicians with up-to-the-minute research and clinical data. Kaiser Permanente’s research program works with national and local health agencies and community organizations to share and widely disseminate its research data. Kaiser Permanente’s research program is funded in part by Kaiser Permanente’s Community Benefit division, which in 2007 directed provided an estimated $1 billion in health services, technology, and funding toward total community health.

About Kaiser Permanente
Kaiser Permanente is America’s leading integrated health plan. Founded in 1945, it is a not-for-profit; group practice prepayment program headquartered in Oakland, Calif. Kaiser Permanente serves the health care needs of 8.7 million members in nine states and the District of Columbia. Today it encompasses the not-for-profit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 159,000 technical, administrative and clerical employees and caregivers, and more than 13, 000 physicians representing all specialties.

Source: Kaiser Permanente