Pregestational Diabetes and Family Planning

Pregestational diabetes is a condition in which a woman with diabetes (most commonly type 1 or type 2 diabetes) before the onset of pregnancy becomes pregnant and therefore vulnerable to increased risk for maternal and fetal adverse outcomes. Pregestational diabetes has been observed in 1–2% of all pregnancies, but rates are rising (1). Approximately one in nine women (14.9 million) have diabetes, and 35% of people with newly diagnosed diabetes are women of reproductive age (2). This means diabetes is increasingly affecting women of childbearing age. Furthermore, nearly one in five adolescents aged 12–18 years and one in four young adults aged 19–34 years are living with prediabetes, which has the potential to cross the threshold into diabetes (3). The increasing prevalence of diabetes among women of reproductive age is largely driven by an increase in type 2 diabetes, which in turn is driven by unhealthy nutrition, obesity, and increasingly sedentary lifestyles (4,5). Pregestational type 2 diabetes disproportionately affects women of ethnic minorities and disadvantaged socioeconomic status. For example, Pacific Islanders, Asian Indians, and Native Americans are more commonly affected by type 2 diabetes (6). In the United States, rates of pregestational diabetes have doubled since 1996, with ∼24% of women having preexisting type 1 diabetes and 76% having preexisting type 2 diabetes (7). The greatest increase is among Hispanic women. Moreover, women with pregestational type 2 diabetes are typically older (≥30 years of age) and more likely to be African American, Hispanic, or Asian (7). Thus, management of pregestational diabetes is not only a racial-ethnic equity issue, but is also important from a clinical impact standpoint. An estimated $327 million in direct medical costs and $90 billion in lost productivity could be saved by implementing comprehensive preconception care for all women diagnosed with diabetes (8). …