Synopsis of the North American Diabetes in Pregnancy Study Group Conference in Little Rock, Arkansas, May 2003

The number of Americans with diabetes continues to grow and further alarm health professionals. Approximately 17 million people in the United States, or 6.2% of the population, have diabetes. While an estimated 11.1 million people have been diagnosed, unfortunately, 5.9 million people (or one-third) are unaware that they have the disease. Among the three types of diabetes, it is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes. Approximately 90–95% (16 million) of Americans who are diagnosed with diabetes have type 2 diabetes. Further estimates reveal that at least 16 million Americans have pre-diabetes, in addition to the 17 million with diabetes. In 1999, approximately 450 000 deaths (or 19% of all deaths) occurred among people with diabetes aged 25 years and older. With diabetes as the sixth leading cause listed on US death certificates in 1999, this figure does not take into account those deaths in which diabetes was an underlying cause of death. Gestational diabetes affects about 4% of all pregnant women (approximately 135 000 cases) in the United States annually and 8.9% of women (or 9.1 million) have pre-gestational diabetes. Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5–10% of pregnancies and spontaneous abortions in 15-20% of pregnancies. To further complicate diabetic pregnancies, in the second and third trimesters, poorly controlled diabetes can result in macrosomia, posing a risk to both mother and child. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and Native Americans. After pregnancy, 5–10% of women with gestational diabetes are found to have type 2 diabetes and women who have had gestational diabetes have a 20–50% chance of developing diabetes in the following 5–10 years. Women with diabetes are up to five times more likely to develop toxemia than women without diabetes, and approximately 40% of women with gestational diabetes who are obese before pregnancy develop type 2 diabetes within 4 years. The cost of diabetes in the United States, both direct and indirect, tops $132 billion, with direct medical costs reported at almost $92 billion, according to the National Diabetes Fact Sheet published by the American Diabetes Foundation. The $132 billion figure is likely to underestimate the true burden of diabetes because it omits intangibles such as care provided by non-paid caregivers and areas such as dental and optometry care, where people with diabetes probably use services at higher rates than people without diabetes. People with diabetes are at a greater risk of incapacity and permanent disability and these also drive up indirect costs. With the number of diabetics and the costs associated with the disease increasing, it is imperative that, as researchers and clinicians, we address the issues that surround diabetes during pregnancy and its effects. The North American Diabetes in Pregnancy Study Group was organized out of the desire that, as a research group, we encourage collaborative research and the translation of these research findings into clinical practice. The Fifth Annual Conference was held in Little Rock, Arkansas in May, 2003. These meetings provide a forum for disseminating new information and the review and management concerns of pregnancies that are complicated by both pre-gestational and gestational diabetes. Salient points from selected presentations are summarized below.