Abstract
Maternal mortality in the United States is on the rise, demonstrating a concerning
trend that stands in stark contrast to the falling rates in other developed countries.
A key challenge facing the improvement of maternal care is the mounting prevalence
of chronic health conditions such as hypertension and diabetes, which are often linked
to poor diet and sedentary lifestyle. Pregestational diabetes now impacts 1 to 2%
of pregnancies, while gestational diabetes affects another 7.8%. Both type 1 and type
2 diabetes elevate the risk of severe maternal morbidity and mortality (SMM), including
severe cardiac morbidity, hypertensive disorders of pregnancy, hemorrhage, infection,
and mental health conditions. The increase in diabetes is thought to account for 17%
of the increase in maternal mortality between 1997 and 2012. Another critical issue
facing maternal care is the significant disparity in pregnancy outcomes among populations
facing greater burdens of adverse social determinants of health, including socioeconomic
characteristics, chronic stress, and systemic racism. For example, non-Hispanic Black
women are 2.5 times more likely to die during pregnancy and the postpartum period
than non-Hispanic White women. Vulnerable populations, often minorities, are also
more likely to develop risk factors for SMM, such as type 2 diabetes. As pregestational
diabetes is a particularly morbid condition in pregnancy, examining its complications
and evidence-based treatments could significantly impact both maternal mortality rates
and disparities in pregnancy outcomes in the United States. This review explores the
relationship between pregestational diabetes and SMM, how the risk of SMM can be modified
by disparities, and avenues for advancing care through future research.
Key Points
-
Diabetes during pregnancy greatly increases the risk of SMM.
-
Comprehensive care can improve outcomes in high-risk pregnancies with diabetes.
-
Adverse social determinants of health worsen outcomes in pregnancies affected by diabetes.
-
Improving diabetes care in pregnancy offers an opportunity to enhance maternal outcomes.
Keywords
pregestational diabetes mellitus - maternal morbidity and mortality - social determinants
of health - disparities - hypertension - nephropathy - pregnancy
