Hyperglycaemia in pregnancy

High blood glucose, or hyperglycaemia, is one of the most common health problems of pregnancy. Hyperglycaemia in pregnancy can be a result of either previously existing diabetes in a pregnant woman, or the development of insulin resistance later in the pregnancy in a condition known as gestational diabetes. 

Unlike diabetes in pregnancy, gestational diabetes resolves once the pregnancy ends. Hyperglycaemia in pregnancy is categorised as either diabetes in pregnancy or gestational diabetes, depending on blood glucose values obtained during screening.

Risks and complications

Any unmanaged hyperglycaemia in pregnancy can result in birth complications that can affect both mother and child including: increased risk of preeclampsia, obstructed labour due to fetal macrosomia and hypoglycaemia at birth for the infant.

As the prevalence of both obesity and diabetes in women of childbearing age continue to rise in all regions, so will the prevalence of hyperglycaemia in pregnancy. In addition, women who develop gestational diabetes have an increased lifetime risk of developing type 2 diabetes.2 Babies born to mothers who have hyperglycaemia in pregnancy are also at an increased risk of developing type 2 diabetes later in life.

Prevalence

IDF estimates that 21.4 million or 16.8% of live births to women in 2013 had some form of hyperglycaemia in pregnancy. An estimated 16% of those cases were due to diabetes in pregnancy and would require careful monitoring during the pregnancy and follow-up post-partum.

There are some regional differences in the prevalence (%) of hyperglycaemia in pregnancy, with the South-East Asia Region having the highest prevalence at 25.0% compared to 10.4% in the North America and Caribbean Region. A staggering 91.6% of cases of hyperglycaemia in pregnancy were in low- and middle-income countries, where access to maternal care is often limited.

The prevalence of hyperglycaemia in pregnancy increases rapidly with age and is highest in women over the age of 45 (47.7%), although there are fewer pregnancies in that age group. This explains why just 23% of global cases of hyperglycaemia in pregnancy occurred in women over the age of 35, even though the risk of developing the condition is higher in these women.

Estimating prevalence

There is great diversity in the methods and criteria used for identifying women with hyperglycaemia in pregnancy, which increases the difficulty of making comparisons between studies and generating estimates on prevalence.

However, the recent

publication of a guideline from the World Health Organization on diagnosing hyperglycaemia in pregnancy will contribute to a standard approach to estimating prevalence.

Data on hyperglycaemia in pregnancy from studies were available for 34 countries across all IDF Regions. Although each of the Regions was represented, the majority of the studies were carried out in high-income countries. More information is available on the methods used to generate the estimates at www.idf.org/diabetesatlas.