(A–C) Prevalence over time of type 1 diabetes (A), type 2 diabetes (B) during pregnancy, and GDM (C) in Sweden 1998–2012 depending on country of birth. GDM, gestational diabetes mellitus.

(A–C) Prevalence over time of type 1 diabetes (A), type 2 diabetes (B) during pregnancy, and GDM (C) in Sweden 1998–2012 depending on country of birth. GDM, gestational diabetes mellitus.

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Objective Diabetes in pregnancy has been shown to increase in parallel with the increasing prevalence of obesity. In this national population-based study, we analyzed the trends for gestational diabetes mellitus (GDM), type 1 diabetes in pregnancy, and type 2 diabetes in pregnancy in Sweden between 1998 and 2012. Research design and methods A popu...

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Background: The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agre...

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... Another regional study from Tuscany, Italy, showed arelatively high attribution of GDM to DM in pregnancy of 95.7% [35]. The study that included the data on more than 1.5 million live births in Sweden between 1998 and 2012 showed that the percentage of GDM among diabetes in pregnancy was just under 75% and that the prevalence of T2DM was 16.6% [36]. The data from the USA showed a similar prevalence of GDM among diabetes in pregnancy, but also ahigh prevalence of T2DM in pregnancy of more than 16%, with less than 2% of diabetes in pregnancy being T1DM [37]. ...
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The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64–0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36–0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55–2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18–1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15–0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM.
... Diagnostic criteria for GDM were relatively strict, particularly during the earlier years of the study, and it is likely that many cases of GDM went undiagnosed. Furthermore, the prevalence of obesity was low in this study by international standards, suggesting that women of childbearing age in Sweden may have been at lower risk of GDM [31]. Nonetheless, we observed an increase in the incidence rate of GDM over the lifetime of this study. ...
... Nonetheless, we observed an increase in the incidence rate of GDM over the lifetime of this study. This is likely to have been driven by increases in maternal age at delivery, rising prevalence of obesity, sedentary lifestyle among some pregnant women, and changes to the diagnostic criteria [20,31,32]. ...
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Background Gestational diabetes (GDM) is associated with increased risk of type 2 diabetes (T2DM) and cardiovascular disease. It is uncertain whether GDM is independently associated with the risk of chronic kidney disease. The aim was to examine the association between GDM and maternal CKD and end-stage kidney disease (ESKD) and to determine whether this depends on progression to overt T2DM. Methods A population-based cohort study was designed using Swedish national registry data. Previous GDM diagnosis was the main exposure, and this was stratified according to whether women developed T2DM after pregnancy. Using Cox regression models, we estimated the risk of CKD (stages 3–5), ESKD and different CKD subtypes (tubulointerstitial, glomerular, hypertensive, diabetic, other). Findings There were 1,121,633 women included, of whom 15,595 (1 · 4%) were diagnosed with GDM. Overall, GDM-diagnosed women were at increased risk of CKD (aHR 1 · 81, 95% CI 1 · 54–2 · 14) and ESKD (aHR 4 · 52, 95% CI 2 · 75–7 · 44). Associations were strongest for diabetic CKD (aHR 8 · 81, 95% CI 6 · 36–12 · 19) and hypertensive CKD (aHR 2 · 46, 95% CI 1 · 06–5 · 69). These associations were largely explained by post-pregnancy T2DM. Among women who had GDM + subsequent T2DM, strong associations were observed (CKD, aHR 21 · 70, 95% CI 17 · 17–27 · 42; ESKD, aHR 112 · 37, 95% CI 61 · 22–206 · 38). But among those with GDM only, associations were non-significant (CKD, aHR 1 · 11, 95% CI 0 · 89–1 · 38; ESKD, aHR 1 · 58, 95% CI 0 · 70–3 · 60 respectively). Conclusion Women who experience GDM and subsequent T2DM are at increased risk of developing CKD and ESKD. However, GDM-diagnosed women who never develop overt T2DM have similar risk of future CKD/ESKD to those with uncomplicated pregnancies.
... The prevalence of diabetes in mothers with gout-offspring, based on a low number of diabetic mothers, was in the current study relatively high, close to 0.7%. However, over the last decades all types of diabetes in pregnancy have increased in both Sweden and worldwide [16,17], especially type 2 diabetes, thus possibly increasing the importance of maternal diabetes in more recent birth cohorts and possibly further adding to the ongoing gout epidemic. ...
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Background Increased level of urate is the strongest risk factor for gout development but since only a minority of hyperuricemics are affected by gout, other pathogenic factors must be considered. Low birth weight is associated with future morbidities causing hyperuricemia, such as diabetes and renal disease. The purpose of this study was to investigate if, and to what extent, maternal and perinatal factors, including birth weight, are associated with future risk of being diagnosed with gout. Methods A population-based retrospective nested case-control registry study based on regional and national health care registers in Sweden. All incident cases of gout born in 1973 and onward who had received ≥1 diagnosis of gout from 2000 through 2019 in the region of western Sweden were included. Up to 5 non-gout controls were matched to each case by age, sex, and county at the year of first gout diagnosis. A range of maternal, gestational, and perinatal factors were analyzed for their potential association to future gout development. This included the health of the mother, gestational length, birth weight, number of siblings, and congenital malformations. Results Maternal diabetes, any congenital malformation, and being small for gestational age were factors that significantly increased the risk for future gout development, odds ratio (95% CI) 3.1 (1.3 to 7.4) ( p =0.01), 1.33 (1.04 to 1.7) ( p =0.02), and 1.75 (1.3 to 2.3) ( p <.0001), respectively. Conclusions In this study, maternal diabetes and being small for gestational age increased the risk for future gout development in young adults. As of today, these conditions are becoming more prevalent and may contribute to the ongoing gout epidemic. These results require both confirmation and further delineation of underlying mechanisms.
... In Europe, the lowest prevalence of 0.4% was from four studies from Spain and the UK [39,41,45,49]. Four studies from Sweden, Malta, Spain and the UK had prevalence between 0.5% and 0.6% [13,34,42,53], and the highest prevalence of 1.2% was from two studies from Finland [37,48]. In Australasia, the lowest prevalence was 0.5% from Fiji during 2013-2015 [62], two studies from Australia reported prevalence between 0.5% and 0.6% [28,55] and the highest prevalence was 1.5% from one study [42] from New Zealand. ...
... Fifteen studies with 51 883 927 women, reported data on the prevalence of pre-existing T1D in pregnancy. Four of these studies were from the USA [3,40,56,57], three from the UK [30,41,49], three from Saudi Arabia [29,51,58], two from Spain [39,53], and one each from Sweden [34], New Zealand [42] and Australia [55]. The prevalence of pre-existing T1D in these studies was between 0.1% and 0.5%, except for the three studies from Saudi Arabia [29,51,58] ...
... Prevalence of pre-existing T2D in pregnancy Nineteen studies [3,27,29,30,32,34,37,[39][40][41][42]49,[51][52][53][55][56][57][58], with 52 892 280 women, provided data on the prevalence of pre-existing type 2 diabetes. Five of the studies were from the USA, three from the UK [30,41,49], three from Saudi Arabia [29,51,58], two from Spain [39,53], and one each from Sweden [34], Canada [32], Finland [37], New Zealand [42] and Australia [55]. ...
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Objectives To estimate the prevalence of pre-existing diabetes in pregnancy from studies published during 2010–2020. Methods We searched PubMed, CINAHL, Scopus and other sources for relevant data sources. The prevalence of overall pre-existing, type 1 and type 2 diabetes, by country, region and period of study was synthesised from included studies using the inverse-variance heterogeneity model and the Freeman-Tukey transformation. Heterogeneity was assessed using the I² statistic and publication bias using funnel plots. Results We identified 2479 records, of which 42 data sources with a total of 78 943 376 women, met the eligibility criteria. The included studies were from 17 countries in North America, Europe, the Middle East and North Africa, Australasia, Asia and Africa. The lowest prevalence was in Europe (0.5%, 95 %CI 0.4–0.7) and the highest in the Middle East and North Africa (2.4%, 95 %CI 1.5–3.1). The prevalence of pre-existing diabetes doubled from 0.5% (95 %CI 0.1–1.0) to 1.0% (95 %CI 0.6–1.5) during the period 1990–2020. The pooled prevalences of pre-existing type 1 and type 2 diabetes were 0.3% (95 %CI 0.2–0.4) and 0.2% (95 %CI 0.0–0.9) respectively. Conclusion While the prevalence of pre-existing diabetes in pregnancy is low, it has doubled from 1990 to 2020.
... PGDM affects 1-4% of pregnancies depending on the population. 1,2 PGDM prevalence continues to rise globally, [3][4][5] partly due to the obesity epidemic and increasing maternal age. 4 PGDM is associated with adverse pregnancy outcomes including congenital malformations, 6 macrosomia, 2 preterm birth 2,7 and increased rates of caesarean delivery. 2,7 It is also associated with worsening diabetes complications such as diabetic retinopathy and nephropathy, [8][9][10] at least during pregnancy, and developing co-morbidities such as preeclampsia and other hypertensive disorders. ...
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Objective: To develop a core outcome set (COS) for randomised controlled trials (RCTs) evaluating the effectiveness of interventions for the treatment of pregnant women with pregestational diabetes mellitus (PGDM). Design: A consensus developmental study. Setting: International. Population: Two hundred and five stakeholders completed the first round. Methods: The study consisted of three components. 1) A systematic review of the literature to produce a list of outcomes reported in RCTs assessing the effectiveness of interventions for the treatment of pregnant women with PGDM. 2) A three-round, online eDelphi survey to prioritise these outcomes by international stakeholders (including healthcare professionals, researchers and women with PGDM). 3) A consensus meeting where stakeholders from each group decided on the final COS. Results: We extracted 131 unique outcomes from 67 records meeting the full inclusion criteria. Of the 205 stakeholders who completed the first round, 174/205 (85%) and 165/174 (95%) completed round 2 and 3, respectively. Participants at the subsequent consensus meeting chose 19 outcomes for inclusion into the COS: trimester specific HbA1c, maternal weight gain during pregnancy, severe maternal hypoglycaemia, diabetic ketoacidosis, miscarriage, pregnancy induced hypertension, pre-eclampsia, maternal death, birth weight, large for gestational age, small for gestational age, gestational age at birth, preterm birth, mode of birth, shoulder dystocia, neonatal hypoglycaemia, congenital malformations, stillbirth and neonatal death. Conclusions: This COS will enable better comparison between RCTs to produce robust evidence synthesis, improve trial reporting and optimise research efficiency in studies assessing treatment of pregnant women with PGDM.
... However, insulin has the associated risks of maternal hypoglycaemia and excessive GWG both of which are unacceptable to women and need to be considered. 6 As the rates of obesity, 11 GDM and type 2 diabetes in pregnancy are all increasing, 12 the need for effective, affordable and safe therapies has never been greater. ...
... Rates of type 2 diabetes in pregnancy are rapidly rising 12 and type 2 diabetes now accounts for 36% and 50% of pregestational diabetes in Ireland and the United Kingdom, respectively. 35,36 This group is particularly at risk for congenital anomalies, PET and macrosomia, and good glycaemic control is essential. ...
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Context and Aim Metformin has been used in pregnancy since the 1970s. It is cheap, widely available and is acceptable to women. Despite its increasing use, controversy remains surrounding its benefits and risks. Metformin effectively reduces hyperglycaemia for the mother during pregnancy and it reduces rates of macrosomia and neonatal hypoglycaemia. However concern exists surrounding an increase in rate of SGA births and obesity in childhood. We aim to review the evidence and expert opinion behind metformin in pregnancy through to the post-partum period. Methods We performed a literature review of relevant studies from online databases using a combination of keywords. We also searched the references of retrieved articles for pertinent studies. Results There is strong evidence that metformin is safe in early pregnancy with no risk of congenital malformations. If used throughout pregnancy it is likely to lead to reduced maternal weight gain and reduced insulin dose in women with type 2 diabetes (T2DM). In infants, metformin reduces hypoglycaemia and macrosomia but may increase the rate of infants born SGA. There is some evidence of an increased risk of obesity and altered fat distribution in offspring. Metformin appears well tolerated in pregnancy and is more acceptable to women than insulin therapy. Conclusion Due to increasing rates of maternal obesity, GDM and T2DM, metformin use in pregnancy is increasing. Overall, it appears safe and effective but further research is needed to examine mechanisms linking metformin to obesity reported during childhood in some follow-up studies.
... The simplicity with which DM is diagnosed belies its highly complex nature and impedes its prevention and treatment. Type 1 DM accounts for~10% of cases, type 2 DM accounts for~90% [46], and 1% of DM occurs in other contexts including gestational DM [47], rare monogenic forms of DM (e.g. mutations in the insulin gene), DM resulting from another disease processes (e.g. ...
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The fields of human genetics and genomics have generated considerable knowledge about the mechanistic basis of many diseases. Genomic approaches to diagnosis, prognostication, prevention and treatment – genomic-driven precision medicine (GDPM) – may help optimize medical practice. Here, we provide a comprehensive review of GDPM of complex diseases across major medical specialties. We focus on technological readiness: how rapidly a test can be implemented into health care. Although these areas of medicine are diverse, key similarities exist across almost all areas. Many medical areas have, within their standards of care, at least one GDPM test for a genetic variant of strong effect that aids the identification/diagnosis of a more homogeneous subset within a larger disease group or identifies a subset with different therapeutic requirements. However, for almost all complex diseases, the majority of patients do not carry established single-gene mutations with large effects. Thus, research is underway that seeks to determine the polygenic basis of many complex diseases. Nevertheless, most complex diseases are caused by the interplay of genetic, behavioural and environmental risk factors, which will likely necessitate models for prediction and diagnosis that incorporate genetic and non-genetic data. Abstract
... The country of birth of the parents significantly predicted the risk of type-1 diabetes with higher risks among children of Swedish and other Nordic mothers and fathers compared with children whose either parent is born outside the Nordic countries. Existing literature had suggested that people from certain countries are more likely to be diabetic than others [1,[47][48][49][50][51]. Studies have shown a higher preponderance of type-1 diabetes in the Scandinavian countries [1,49,50]. ...
... Existing literature had suggested that people from certain countries are more likely to be diabetic than others [1,[47][48][49][50][51]. Studies have shown a higher preponderance of type-1 diabetes in the Scandinavian countries [1,49,50]. Although the reasons for these differences are yet to be well articulated in the literature. ...
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The goal is to examine the risk of conception mode-type-1 diabetes using different survival analysis modelling approaches and examine if there are differentials in the risk of type-1 diabetes between children from fresh and frozen-thawed embryo transfers. We aimed to compare the performances and fitness of different survival analysis regression models with the Cox proportional hazard (CPH) model used in an earlier study. The effect of conception modes and other prognostic factors on type-1 diabetes among children conceived either spontaneously or by assisted reproductive technology (ART) and its sub-groups was modelled in the earlier study. We used the information on all singleton children from the Swedish Medical Birth Register hosted by the Swedish National Board of Health and Welfare, 1985 to 2015. The main explanatory variable was the mode of conception. We applied the CPH, parametric and flexible parametric survival regression (FPSR) models to the data at 5% significance level. Loglikelihood, Akaike and Bayesian information criteria were used to assess model fit. Among the 3,138,540 singletons, 47,938 (1.5%) were conceived through ART (11,211 frozen-thawed transfer and 36,727 fresh embryo transfer). In total, 18,118 (0.58%) of the children had type-1 diabetes, higher among (0.58%) those conceived spontaneously than the ART-conceived (0.42%). The median (Interquartile range (IQR)) age at onset of type-1 diabetes among spontaneously conceived children was 10 (14–6) years, 8(5–12) for ART, 6 (4–10) years for frozen-thawed embryo transfer and 9 (5–12) years for fresh embryo transfer. The estimates from the CPH, FPSR and parametric PH models are similar. There was no significant difference in the risk of type-1 diabetes among ART- and spontaneously conceived children; FPSR: (adjusted Hazard Ratio (aHR) = 1.070; 95% Confidence Interval (CI):0.929–1.232, p = 0.346) vs CPH: (aHR = 1.068; 95%CI: 0.927–1.230, p = 0.361). A sub-analysis showed that the adjusted hazard of type-1 diabetes was 37% (aHR = 1.368; 95%CI: 1.013–1.847, p = 0.041) higher among children from frozen-thawed embryo transfer than among children from spontaneous conception. The hazard of type-1 diabetes was higher among children whose mothers do not smoke (aHR = 1.296; 95%CI:1.240–1.354, p<0.001) and of diabetic mothers (aHR = 6.419; 95%CI:5.852–7.041, p<0.001) and fathers (aHR = 8.808; 95%CI:8.221–9.437, p<0.001). The estimates from the CPH, parametric models and the FPSR model were close. This is an indication that the models performed similarly and any of them can be used to model the data. We couldn’t establish that ART increases the risk of type-1 diabetes except when it is subdivided into its two subtypes. There is evidence of a greater risk of type-1 diabetes when conception is through frozen-thawed transfer.
... Other parameters exhibiting increasing trends were preterm delivery (both <35 weeks and <37 weeks), low birth weight (<2500 g), and fetal death; trends of Apgar scores of <7 at 5 min did not increase 37 . An ongoing epidemic of obesity and diabetes exist globally, and this has led to higher rates of type 2 diabetes among women of reproductive age, with an increase in the number of pregnant women with undiagnosed prediabetes or type 2 diabetes during early pregnancy. ...
... Hyperglycemic surveillance should also be performed for all pregnancies at the first prenatal visit to exclude prediabetes and diabetes. Postpartum long-term follow-up of mothers with GDM and their offspring is required for effective lifestyle changes, early detection, and costeffective treatment for MS, obesity, prediabetes, and diabetes 9,37,40,41,4,42 . Coordinated multisectorial public health policies are required to end the vicious cycle of GDM and its subsequent effects on both mothers with GDM and their offspring 43 . ...
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Aims /Introduction Maternal hyperglycemia leads to adverse pregnancy outcomes and also subsequently affects both mothers and their offspring in later life. The prevalence of type 2 diabetes mellitus is increasing worldwide, and gestational diabetes mellitus (GDM) is also believed to be increasing. More precise nationwide and up-to-date data on GDM are required. Materials and Methods A population-based retrospective cohort study was conducted with the Birth Certificate Application database and linked to the National Health Insurance Research Database (NHIRD) to explore trends in the annual crude prevalence of GDM in all women who gave birth between January 1, 2004, and December 31, 2015, in Taiwan and their pregnancy outcomes. The registry is considered complete, reliable, and accurate. Results A total of 2 468 793 births from 2 430 307 pregnancies were reported between January 1, 2004 and December 31, 2015. Finally, 2 053 305 pregnancies were included for further analysis. The annual prevalence of GDM increased by 1.8 times during the 12 years from 2004 to 2015, with a significant continuous increasing trend (from 7.6% to 13.4%, P < 0.001). The annual prevalence of GDM significantly increased in each age group (all trends P < 0.001), particularly for women with maternal ages of 31 years and older. Urbanization level, geographic risk factors, and seasonal variations were also noted. Conclusion The annual prevalence of GDM increased 1.8 times in the 12-year period from 2004 to 2015 in Taiwan, with a significant continuous increasing trend (from 7.6% to 13.4%, P < 0.001).
... In our cohort, 127 women (14.9%) in total were diagnosed with GDM, which is high in comparison to numbers seen in most other Nordic countries, such as Sweden (1.4-2.6%) (47,48), Denmark (2.3-2.9%) (49,50), and Norway (5.2-7.4%) ...
Article
Background A diet rich in whole grains may provide benefits for pregnant women due to whole grains’ high nutritional value and dietary fiber content. Objectives To study the associations of whole-grain consumption, as well as the plasma alkylresorcinol concentration, a whole-grain consumption biomarker, in early pregnancy with gestational diabetes mellitus (GDM) diagnoses. Methods Subjects were women from the prospective study Pregnant Women in Iceland II (PREWICE II; n = 853) who attended their ultrasound appointment in gestational weeks 11–14 during the period from October 2017 to March 2018. During that visit, whole-grain consumption was estimated using a diet screening questionnaire, and blood samples were collected for analysis of plasma alkylresorcinols (ARs). Information on GDM diagnoses was later extracted from medical records. Multivariate log-binomial regression was used to evaluate the association of dietary whole-grain and AR concentrations with GDM. Results In total, 14.9% of the women adhered to the national food-based dietary guidelines (n = 127), which recommend 2 portions of whole grains daily. GDM was diagnosed in 127 women (14.9%). The frequency of whole-grain consumption was lower in women who were later diagnosed with GDM compared to the women without GDM (median, 5 times/week vs. 6 times/week, respectively; P = 0.02). This difference was reflected in the lower median concentration of total AR in women diagnosed with GDM (163 nmol/L vs. 209 nmol/L, respectively; P < 0.01). The quartile with the highest concentrations of AR had a RR of 0.50 (95% CI: 0.27–0.90) of being diagnosed with GDM, in comparison to the lowest quartile. There was a significant dose response in the GDM risk with higher AR levels. Conclusions We found that a higher consumption of whole grains, reflected both by reported consumption according to the FFQ and AR biomarkers, was associated with a decreased risk of receiving a GDM diagnosis.