20 24 The desired key to reducing overall disease burden and sociocultural inequities is to close the gap by reducing prevalence selleck chem inhibitor among high-risk groups and to contain and ideally reduce the prevalence among lower risk groups. Our findings differ from recent national reports that GDM increased to a similar extent among Australian-born

(23% increase) and all overseas-born mothers collectively (24% increase), with differential increases between individual migrant groups, for the period 2000–2001 and 2005–2006.20 That GDM burden in Victoria increased over time among all migrant groups collectively but not individually may be due to the fact that the proportion of mothers born in high prevalence regions and giving birth in Victoria has increased over time,39 but our study may have been underpowered to detect differences within individual migrant groups. Alternatively, it is possible that risk factor distribution or screening uptake may have changed more over time for some groups

than others, or that there is a difference in the proportion of diagnosed to undiagnosed diabetes between migrants and local-born women. Future research should seek to confirm our results and investigate underlying causes. In contrast to earlier findings,3 recent work suggests that in the Australian obstetric population, pre-existing type 2 diabetes is now as common as type 1 diabetes,2 and even the predominant form of pre-existing diabetes in pregnancy.40 The increasing number of pregnancies in women with pre-existing diabetes observed in our study is consistent with international findings7–9 11 12 and reinforces the urgent

need for population-level preventive initiatives to address the growing public health problem of diabetes in the young. These upward trends are likely to continue, particularly in the setting of the obesity and type 2 diabetes epidemics in the general population,36 evidence of earlier onset of type 2 AV-951 diabetes, trends toward delayed childbearing39 and introduction of new antenatal screening guidelines6 32 that will increase case detection. There are a number of strengths to this study. This is one of few papers to report secular trends in Australian population-level prevalence of pre-existing diabetes in pregnancy3 and to our knowledge, the only one to present data spanning a decade. It is also one of few Australian studies, and the first from Victoria since the early 1990s, to report ethnospecific secular trends in GDM prevalence. This is important because of Australia’s diverse and evolving multiethnic demography.