Diabetes in Pregnancy in Korea: Prevalence, Clinical Characteristics, and Postpartum Comorbidities

BACKGRUOUND: Diabetes in pregnancy (DIP), encompassing gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM), has limited nationwide data in Korea. This study aimed to evaluate the clinical characteristics and management of DIP using representative national data. METHODS: Using the Korean National Health Insurance Service database, we analyzed 3,451,648 delivery records from 2013 to 2023 and 1,401,233 health examination records. The prevalence of DIP according to maternal factors, management modalities, and postpartum surveillance was examined. Long-term cardiovascular disease (CVD) risk was evaluated among 3,068,834 deliveries from 2003 to 2013 using Cox regression models. RESULTS: The prevalence of GDM and PGDM increased over the decade, reaching 12.4% and 2.1% in 2023. Both were more common with advancing maternal age, adiposity, and preexisting hypertension or dyslipidemia. Approximately 90% of women with GDM were managed by lifestyle modification alone, whereas 70% with PGDM received insulin monotherapy. Postpartum glycemic testing within 1 year increased from 32.0% to 42.9% for GDM and from 61.1% to 68.1% for PGDM between 2018 and 2022, though rates remained suboptimal. During a median follow-up of 13.4 to 16.2 years, CVD risk was significantly higher in women with GDM (adjusted hazard ratio [aHR], 1.47; 95% confidence interval [CI], 1.40 to 1.55) and PGDM (aHR, 3.04; 95% CI, 2.82 to 3.28) than in those without DIP. CONCLUSION: The prevalence of DIP is rising in Korea, particularly among older and metabolically unhealthy women. Despite this burden, postpartum glucose surveillance remains insufficient, and DIP is linked to increased long-term cardiovascular risk, underscoring the need for improved postpartum monitoring and preventive care.