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Aim: To compare perinatal outcomes in women with undiagnosed diabetes with gestational diabetes alone, pre‐existing diabetes and women without diabetes, and to identify risk factors which distinguish them from women with gestational diabetes alone. Methods: This population‐based cohort study included administrative data on all women who gave birth in Ontario, Canada, during 2002–2015. Maternal/neonatal outcomes were compared across groups using logistic regression, adjusting for confounders. A nested case control study compared women with undiagnosed type 2 diabetes with women with gestational diabetes alone to determine risk factors that would help identify these women. Results: Among 995 990 women, 68 163 had gestational diabetes (6.8%) and, of those women with gestational diabetes,1772 had undiagnosed type 2 diabetes (2.6%). Those with undiagnosed type 2 diabetes were more likely to be older, from a lower income area, have parity > 3 and BMI ≥ 30 kg/m2 compared with gestational diabetes alone. Infants had a higher risk of perinatal mortality (OR 2.3 [1.6–3.4]), preterm birth (OR 2.6 [2.3–2.9]), congenital anomalies (OR 2.1 [1.7–2.5]), neonatal intensive care unit admission (OR 3.1 [2.8–3.5]) and neonatal hypoglycaemia (OR 406.0 [357–461]), which were similar to women with pre‐existing diabetes. The strongest predictive risk factors included early gestational diabetes diagnosis, previous gestational diabetes and chronic hypertension. Conclusions: Women diagnosed with gestational diabetes who develop diabetes within 1 year postpartum are at higher risk of adverse pregnancy outcomes, including perinatal mortality. This highlights the need for earlier diagnosis, preferably pre‐pregnancy, and more aggressive treatment and surveillance of suspected type 2 diabetes during pregnancy. What's new?: While it is suspected that several women with a diagnosis of gestational diabetes have undiagnosed type 2 diabetes, no study has followed these women through the first year postpartum to see the prevalence of actual undiagnosed type 2 diabetes during pregnancy and the maternal and neonatal outcomes of these women.This study found that 26 per 1000 women with gestational diabetes had undiagnosed type 2 diabetes.Infants of women with undiagnosed type 2 diabetes had a higher risk of adverse pregnancy outcomes including perinatal mortality compared with women with gestational diabetes alone.This study highlights the need for earlier diagnosis, preferably pre‐pregnancy, and more aggressive treatment and surveillance of suspected type 2 diabetes cases during pregnancy. [ABSTRACT FROM AUTHOR]

Aim To determine what proportion of women with gestational diabetes underestimate their diabetes risk and identify factors associated with low diabetes risk perception. Methods Participants included pregnant adult women with gestational diabetes between 2009 and 2012 across seven diabetes clinics in Ontario, Canada. Data were collected through chart review and a survey that included a diabetes risk perception question. Results Of the 614 of 902 women (68% response rate) with gestational diabetes, 89% correctly responded that gestational diabetes increases the risk for developing diabetes. However, 47.1% of women perceived themselves to be at low risk for developing diabetes within 10 years. On multivariable analysis, BMI < 25 kg/m2, absent previous gestational diabetes history, absent diabetes family history and absent insulin use were appropriately associated with low diabetes risk perception. However, compared with Caucasian ethnicity, high-risk ethnicity (Aboriginal, Latin American, West Indian, South Asian, Middle Eastern, Filipino, Black, Pacific Islander) [odds ratio ( OR) 2.07; 95% CI 1.30-3.31] and East and South East Asian ethnicity ( OR 2.01; 1.10-3.67) were associated with low diabetes risk perception. After further adjustment for immigration, only high-risk ethnicity remained a predictor of low diabetes risk perception ( OR 1.86; 1.09-3.19), whereas East and South East Asian ethnicity did not ( OR 1.67; 0.86-3.22). Conclusions Although the majority of women recognized gestational diabetes as a risk factor for diabetes, almost half underestimated their personal high diabetes risk despite prenatal care. Furthermore, women from high-risk ethnic groups were more likely to underestimate their risk, even after adjusting for immigration. Interventions tailored to these groups are necessary to enhance perceived diabetes risk. [ABSTRACT FROM AUTHOR]

Aims To assess the combined impact of socio-economic status and gender on the risk of diabetes-related lower extremity amputation within a universal healthcare system. Methods We conducted a population-based cohort study using administrative health databases from Ontario, Canada. Adults with pre-existing or newly diagnosed diabetes (N = 606 494) were included and the incidence of lower extremity amputation was assessed for the period 1 April 2002 to 31 March 2009. Socio-economic status was based on neighbourhood-level income groups, assigned to individuals using the Canadian Census and their postal code of residence. Results Low socio-economic status was associated with a significantly higher incidence of lower extremity amputation (27.0 vs 19.3 per 10,000 person-years in the lowest (Q1) vs the highest (Q5) socio-economic status quintile. This relationship persisted after adjusting for primary care use, region of residence and comorbidity, and was greater among men (adjusted Q1:Q5 hazard ratio 1.41, 95% CI 1.30-1.54; P < 0.0001 for all male gender-socio-economic status interactions) than women (hazard ratio 1.20, 95% CI 1.06-1.36). Overall, the incidence of lower extremity amputation was higher among men than women (hazard ratio for men vs women: 1.87, 95% CI 1.79-1.96), with the greatest disparity between men in the lowest socio-economic status category and women in the highest (hazard ratio 2.39, 95% CI 2.06-2.77 and hazard ratio 2.30, 95% CI 1.97-2.68, for major and minor amputation, respectively). Conclusions Despite universal access to hospital and physician care, we found marked socio-economic status and gender disparities in the risk of lower extremity amputation among patients with diabetes. Men living in low-income neighbourhoods were at greatest risk. [ABSTRACT FROM AUTHOR]