Diabetes is the most common medical disorder complicating
pregnancy accounting for 0.2-0.5% of all births.
It affects about 1:264 pregnant women in England,
Wales and Northern Ireland.
Type 1 Diabetes occurs mainly in children and young
adults as a result of failure of the islet cells
in the pancreas. These sufferers are totally insulin
deficient and will always require insulin. Type
1 diabetes represents about 15% of all adult cases.
Type 2 diabetes mainly occurs in older adults but
there are several reports of it occurring in a younger
population even in adolescent groups. The increased
number of reported cases appears to parallel the
growing obesity rates. These sufferers have a relative
deficiency of insulin as a result of partial pancreatic
failure. In addition the insulin produced does not
work effectively due to the presence of insulin resistance
in the liver and skeletal muscle. These patients
may be treated with insulin and/or oral hypoglycaemic
agents in addition to diet and exercise. This form
of diabetes represents about 85% of all adult cases.
In the West Midlands, 1:236 births
affected by maternal pre-gestational diabetes
the West Midlands
Perinatal mortality rates along
with congenital malformation rates are higher
in the diabetic population. In the West Midlands
Perinatal Mortality rates are 45.6 /1000
births & congenital
malformation rates 82.1/1000 births.
In the West Midlands the perinatal
mortality rate (PMR) is 40%
higher than the UK diabetic maternity population
(reference CEMACH 2005) and major congenital
anomalies are twice as high as nationally.
Figures show there is a 4-5
fold increase in PMR,
and a 4 fold increase in congenital malformation
rate (CMR) compared with that of the background
Most women with pregnancies
complicated with diabetes are treated / switched
on a insulin regime in pregnancy
mellitus (GDM) is a type of diabetes that arises
during pregnancy, more commonly
appearing in the 2nd or 3rd trimester. Women with
GDM have a higher risk of developing type 2 diabetes
during their lifetime. Women from certain ethnic
groups have a higher prevalence rate (African,
African-Caribbean and Asian) and are more likely
to develop type 2 diabetes if they have had GDM.
GDM detected during the first trimester of pregnancy
may indicate that diabetes most likely existed
before the pregnancy. GDM occurs in some women
because the body cannot produce enough insulin
to meet the extra needs of pregnancy.
Recent evidence suggests that pregnancies
complicated by gestational diabetes are at an increased
risk compared to background maternity population.
This includes higher rates of early pregnancy loss,
stillbirth and neonatal morbidity