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Association between Preexisting Type 1 and Type 2 Diabetes and Severe Maternal Morbidity
Laura Chaves Cerdas1, Clare C Brown1
1Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, United States.
American Journal of Preventive Medicine
|May 28, 2026
Summary
Pregnant individuals with type 1 or type 2 diabetes face higher severe maternal morbidity (SMM) risks. Type 1 diabetes poses a greater SMM risk than type 2 diabetes during pregnancy and postpartum.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Public Health
Background:
- Comorbidities during pregnancy increase severe maternal morbidity (SMM) risk.
- Limited data exists on distinct SMM risks from type 1 vs. type 2 pregestational diabetes throughout pregnancy and postpartum.
Purpose of the Study:
- To compare SMM risk in pregnant individuals with type 1 or type 2 diabetes versus those without diabetes.
- To analyze SMM risk across pregnancy and postpartum periods stratified by diabetes type.
Main Methods:
- Utilized Arkansas All-Payer Claims Database linked to birth records (2017-2024).
- Employed multivariable logistic regression on 176,708 pregnancies.
- Evaluated SMM, with and without blood transfusions, for type 1, type 2, and no diabetes groups.
Main Results:
- Type 1 diabetes associated with 2.2% higher SMM probability (p<0.0001).
- Type 2 diabetes associated with 1.5% higher SMM probability (p<0.0001).
- Results consistent when excluding blood transfusions.
Conclusions:
- Preexisting diabetes elevates severe maternal morbidity risk in pregnancy.
- Type 1 diabetes presents a higher risk of SMM compared to type 2 diabetes.
- Emphasizes need for comprehensive diabetes management adherence during pregnancy.
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