ABSTRACT
The epidemic of diabetes is affecting all ethnic groups as changing habits with increased calorific intake and reduced energy expenditure spread worldwide. The impact of this now affects increasing numbers of women in the child bearing age group, so that more women are entering pregnancy with diagnosed diabetes, i.e. pre-gestational diabetes, and more are developing gestational diabetes. This rise in all forms of diabetes and particularly of
type 2 is well established. In the US the incidence of type 2 diabetes in the 30-39-year-old age range increased by 70% between 1990 and 1998, double the rate for the population as a whole.1 Onkamo et al2
reported in 1999 that there was an average annual increase in the incidence of type 1 diabetes of 3% (95% confidence interval (CI) 2.6-3.3) from studies conducted in 27 countries and this dated from the middle of the 20th century. In the US the proportion of pregnancies in women with type 2 diabetes compared with those with type 1 diabetes virtually trebled between 1980 and 1988, increasing from 26 to 65%. In the UK there has been up to a 6-fold increase in the incidence of pregnancies in women with type 2 diabetes, from 0.2 per 1000 pregnancies in 1996-98 to 1.2 per 1000 in 2002-4. The incidence of women with type 1 diabetes rose
from 2.9 per 1000 to 3.5 per 1000 in the same time interval.3 The implication of this is that more women with pre-existing type 1 diabetes are now entering the child bearing years. The obesity epidemic is also affecting both devel-
oped and developing societies. In the US the proportion of the population with a body mass index (BMI) of >30 rose from 22.9% in 1994 to 30.5% in 2000.4 Of even more concern is that the prevalence of overweight in adolescents increased by 11.3%.5 In Australia, the prevalence of obesity was 2.5 times higher in 2000 than in 1980, affecting 34% of women, and overall 60% of the population were overweight or obese.6
