{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:24:19Z","timestamp":1763558659842,"version":"3.45.0"},"reference-count":50,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Diabetes mellitus (DM) in pregnancy, including type 1 (T1DM), type 2 (T2DM), and gestational DM (GDM), represents an increasing health burden due to its maternal and fetal complications. Despite the increment in the global prevalence estimates of DM in pregnancy, in Romania, it has not been comprehensively described. This study aimed to analyze the prevalence and dynamics of DM in pregnancy in Romania between 2014 and 2024, using national databases, and to identify prevention strategies for reducing maternal and fetal complications. Methods: Data were obtained from the Romanian National Public Health Institute through two distinct sources: Database 1, consisting of reports from public and medical units associated with the National Health Insurance House and Database 2, based on the reports from general practitioners. Pregnancies complicated by DM were assessed by type, age group, and environmental settlement. Additional data were extracted on pregnancies with insufficient prenatal care and those of socially vulnerable individuals. Results: From 2014 to 2024, the prevalence of DM in pregnancy in Romania was consistently lower than European and global estimates, ranging from 1.01\u2030 to 3.08\u2030 in Database 1 and from 0.84\u2030 to 5.88\u2030 in Database 2, respectively. GDM accounted for the majority of cases, accounting for 65\u201388% of reported DM in pregnancy. The highest incidence was observed in the 20\u201339 years age group, with a growing proportion in women aged \u226540 years. Urban-rural disparities decreased over the decade, with rural cases reaching parity by 2024. Vulnerable populations included adolescents, women with insufficient prenatal care, and those with social risk factors, predominantly from rural areas. Conclusions: Although the reported prevalence of DM in pregnancy in Romania is lower than international figures, the true burden is likely underestimated. GDM remains the leading type of DM in pregnancy, mirroring global trends. Strengthening the reporting system, standardizing diagnostic criteria, and targeting high-risk groups through preconceptional counselling, lifestyle interventions, advanced monitoring technologies, and improving social support through the involved authorities are crucial steps to reduce maternal and fetal morbidity.<\/jats:p>","DOI":"10.3390\/jcm14228135","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:55:31Z","timestamp":1763556931000},"page":"8135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diabetes in Pregnant Romanian Patients\u2014Epidemiology and Prevention Strategies Proposal"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8957-737X","authenticated-orcid":false,"given":"Bianca-Margareta","family":"Salmen","sequence":"first","affiliation":[{"name":"Doctoral School, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4548-7441","authenticated-orcid":false,"given":"Teodor","family":"Salmen","sequence":"additional","affiliation":[{"name":"Doctoral School, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Pitesti Emergency County Hospital, 110283 Pitesti, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3116-8151","authenticated-orcid":false,"given":"Delia","family":"Reurean-Pintilei","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical and Complementary Sciences, Faculty of Medicine and Biological Sciences, \u201c\u0218tefan cel Mare\u201d University, 720229 Suceava, Romania"},{"name":"Department of Diabetes, Nutrition and Metabolic Diseases, Consultmed Medical Centre, 700544 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Vaida","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Altstadtpraxis Aarau GmbH, 5000 Aarau, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana-Elena","family":"Bohiltea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, \u2018Carol Davila\u2019 University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.2337\/dci23-0036","article-title":"Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus","volume":"46","author":"Sacks","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2025). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care, 48, S27\u2013S49.","DOI":"10.2337\/dc25-S002"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ye, J., Wu, Y., Yang, S., Zhu, D., Chen, F., Chen, J., Ji, X., and Hou, K. (2023). The global, regional and national burden of type 2 diabetes mellitus in the past, present and future: A systematic analysis of the Global Burden of Disease Study 2019. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1192629"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/jdi.13101","article-title":"Comparison of pregnancy outcomes between women with early-onset and late-onset gestational diabetes in a retrospective multi-institutional study in Japan","volume":"11","author":"Usami","year":"2020","journal-title":"J. Diabetes Investig."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1001\/jama.2022.3189","article-title":"Risk of Adverse Pregnancy Outcomes Among Pregnant Individuals With Gestational Diabetes by Race and Ethnicity in the United States, 2014\u20132020","volume":"327","author":"Venkatesh","year":"2022","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"410.e1","DOI":"10.1016\/j.ajog.2015.05.022","article-title":"The risk of fetal death in nonanomalous pregnancies affected by polyhydramnios","volume":"213","author":"Pilliod","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"The American College of Obstetricians and Gynecologists (2021). Fetal Growth Restriction: ACOG Practice Bulletin, Number 227. Obstet. Gynecol., 137, e16\u2013e28.","DOI":"10.1097\/AOG.0000000000004251"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1097\/AOG.0000000000004117","article-title":"Characteristics of Stillbirths Associated With Diabetes in a Diverse U.S. Cohort","volume":"136","author":"Page","year":"2020","journal-title":"Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.ogc.2007.03.001","article-title":"Diabetic-associated stillbirth: Incidence, pathophysiology, and prevention","volume":"34","author":"Dudley","year":"2007","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.2337\/dc07-0278","article-title":"Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with prepregnancy diabetes","volume":"30","author":"Guerin","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"176.e1","DOI":"10.1016\/j.ajog.2019.08.028","article-title":"Specific birth defects in pregnancies of women with diabetes: National Birth Defects Prevention Study, 1997\u20132011","volume":"222","author":"Tinker","year":"2020","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1186\/1757-1626-1-407","article-title":"Caudal regression syndrome and popliteal webbing in connection with maternal diabetes mellitus: A case report and literature review","volume":"1","author":"Klaushofer","year":"2008","journal-title":"Cases J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2337\/dc11-1790","article-title":"The hyperglycemia and adverse pregnancy outcome study: Associations of GDM and obesity with pregnancy outcomes","volume":"35","author":"Catalano","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_14","first-page":"2460","article-title":"Dietary behavior during pregnancy","volume":"20","author":"Iordachescu","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/AOG.0000000000001863","article-title":"Pregnancies After the Diagnosis of Mild Gestational Diabetes Mellitus and Risk of Cardiometabolic Disorders","volume":"129","author":"Varner","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s00125-019-4840-2","article-title":"Gestational diabetes and the risk of cardiovascular disease in women: A systematic review and meta-analysis","volume":"62","author":"Kramer","year":"2019","journal-title":"Diabetologia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1038\/s41581-022-00645-1","article-title":"Youth-onset type 2 diabetes mellitus: An urgent challenge","volume":"19","author":"Bjornstad","year":"2023","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"m1361","DOI":"10.1136\/bmj.m1361","article-title":"Progression to type 2 diabetes in women with a known history of gestational diabetes: Systematic review and meta-analysis","volume":"369","author":"Vounzoulaki","year":"2020","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"F65","DOI":"10.1136\/archdischild-2015-309750","article-title":"Diabetes in pregnancy and infant adiposity: Systematic review and meta-analysis","volume":"102","author":"Logan","year":"2017","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_20","first-page":"83","article-title":"Effect of diabetes in pregnancy on offspring: Follow-up research in the Pima Indians","volume":"9","author":"Dabelea","year":"2000","journal-title":"J. Matern. Fetal Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1002\/dmrr.2656","article-title":"Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy","volume":"31","author":"Liang","year":"2015","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"858","DOI":"10.2337\/dc20-2941","article-title":"Resolving the Gestational Diabetes Diagnosis Conundrum: The Need for a Randomized Controlled Trial of Treatment","volume":"44","author":"Bilous","year":"2021","journal-title":"Diabetes Care"},{"key":"ref_23","first-page":"1","article-title":"Trends and Characteristics in Gestational Diabetes: United States, 2016\u20132020","volume":"71","author":"Gregory","year":"2022","journal-title":"Natl. Vital Stat. Rep."},{"key":"ref_24","unstructured":"(2025, September 18). National Institute of Public Health\u2014National Center for Public Health Statistics (Data Collected by the Public Health Department from General Practitioners\u2019 Offices\/Reports of Medical Units (Under Contract with National Health Insurance House) from the Public and Private Sectors, according to Health Minister Order No. 1782\/2006), Available online: https:\/\/insp.gov.ro\/centrul-national-de-statistica-in-sanatate-publica-cnssp\/contact\/."},{"key":"ref_25","unstructured":"Romanian Society of Diabetes, Nutrition and Metabolic Diseases (2025, October 01). Diabetes Mellitus Management Guide. Available online: https:\/\/societate-diabet.ro\/wp-content\/uploads\/2021\/07\/Ghidul-SRDNBM-2021.pdf."},{"key":"ref_26","unstructured":"GBD 2021 Fertility and Forecasting Collaborators (2024). Global fertility in 204 countries and territories, 1950\u20132021, with forecasts to 2100: A comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet, 403, 2057\u20132099."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"109049","DOI":"10.1016\/j.diabres.2021.109049","article-title":"IDF Diabetes Atlas: The prevalence of pre-existing diabetes in pregnancy\u2014A systematic reviewand meta-analysis of studies published during 2010\u20132020","volume":"183","author":"Chivese","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Paulo, M.S., Abdo, N.M., Bettencourt-Silva, R., and Al-Rifai, R.H. (2021). Gestational Diabetes Mellitus in Europe: A Systematic Review and Meta-Analysis of Prevalence Studies. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.691033"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Dugalic, S., Petronijevic, M., Vasiljevic, B., Todorovic, J., Stanisavljevic, D., Jotic, A., Lukic, L., Milicic, T., Lali\u0107, N., and Lalic, K. (2022). Trends of the Prevalence of Pre-gestational Diabetes in 2030 and 2050 in Belgrade Cohort. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19116517"},{"key":"ref_30","first-page":"81","article-title":"Pregnancy Complications in Women With Pregestational and Gestational Diabetes Mellitus","volume":"120","author":"Reitzle","year":"2023","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"161","DOI":"10.5694\/mja2.52696","article-title":"Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes","volume":"223","author":"Sweeting","year":"2025","journal-title":"Med. J. Aust."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"281","DOI":"10.11604\/pamj.2020.37.281.21798","article-title":"Prevalence of gestational diabetes and associated risk factors in the population of Safi Province in Morocco","volume":"37","author":"Chamlal","year":"2020","journal-title":"Pan Afr. Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/1471-0528.17587","article-title":"Rural-urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross-sectional analysis of over 12\u2009million pregnancies","volume":"131","author":"Venkatesh","year":"2024","journal-title":"BJOG"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"219","DOI":"10.20344\/amp.11057","article-title":"Advanced Maternal Age: Adverse Outcomes of Pregnancy, A Meta-Analysis","volume":"32","author":"Pinheiro","year":"2019","journal-title":"Acta Med. Port."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1089\/jwh.2020.8860","article-title":"Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age","volume":"30","author":"Yoon","year":"2021","journal-title":"J. Women's Health (Larchmt)"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2025). 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2025. Diabetes Care, 48, S306\u2013S320.","DOI":"10.2337\/dc25-S015"},{"key":"ref_37","unstructured":"U.S. Department of Health and Human Services (2025, July 13). Physical Activity Guidelines for Americans, Available online: https:\/\/health.gov\/sites\/default\/files\/2019-09\/Physical_Activity_Guidelines_2nd_edition.pdf."},{"key":"ref_38","unstructured":"(2025, July 12). Dietary Reference Intakes: The Essential Guide to Nutrient Requirements, Available online: https:\/\/nap.nationalacademies.org\/catalog\/11537\/dietary-reference-intakes-the-essential-guide-to-nutrient-requirements."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.2337\/dc13-2411","article-title":"A higher-complex carbohydrate diet in gestational diabetes mellitus achieves glucose targets and lowers postprandial lipids: A randomized crossover study","volume":"37","author":"Hernandez","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.ajog.2021.12.035","article-title":"The importance of nutrition in pregnancy and lactation: Lifelong consequences","volume":"226","author":"Marshall","year":"2022","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"The American College of Obstetricians and Gynecologists (2018). ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet. Gynecol., 131, e49\u2013e64.","DOI":"10.1097\/AOG.0000000000002501"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Salmen, B.M., Reurean-Pintilei, D., Salmen, T., and Boh\u00eel\u021bea, R.E. (2025). Exploring Continuous Glucose Monitoring in Gestational Diabetes: A Systematic Review. Life, 15.","DOI":"10.3390\/life15091369"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"188","DOI":"10.21037\/atm.2018.03.08","article-title":"Does continuous glucose monitoring during pregnancy improve glycaemic and health outcomes in women with type 1 diabetes?-what the CONCEPTT trial adds","volume":"6","author":"Farrar","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1089\/dia.2019.0319","article-title":"Continuous Glucose Monitoring and Glycemic Patterns in Pregnant Women with Gestational Diabetes Mellitus","volume":"22","year":"2020","journal-title":"Diabetes Technol. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Wei, Q., Sun, Z., Yang, Y., Yu, H., Ding, H., and Wang, S. (2016). Effect of a CGMS and SMBG on Maternal and Neonatal Outcomes in Gestational Diabetes Mellitus: A Randomized Controlled Trial. Sci. Rep., 6.","DOI":"10.1038\/srep19920"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.diabres.2006.12.012","article-title":"Continuous glucose monitoring versus self-monitoring of blood glucose in the treatment of gestational diabetes mellitus","volume":"77","author":"Ekblad","year":"2007","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s13098-016-0161-5","article-title":"Use of a RT continuous glucose monitoring system as an educational tool for patients with gestational diabetes","volume":"8","author":"Alfadhli","year":"2016","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_48","first-page":"S48","article-title":"Insulin therapy in pregnancy","volume":"66","author":"Kalra","year":"2016","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3892\/etm.2020.9512","article-title":"Gestational diabetes\u2014Modern management and therapeutic approach (Review)","volume":"21","author":"Sandu","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Gitsi, E., Livadas, S., Angelopoulos, N., Paparodis, R.D., Raftopoulou, M., and Argyrakopoulou, G. (2023). A Nutritional Approach to Optimizing Pump Therapy in Type 1 Diabetes Mellitus. Nutrients, 15.","DOI":"10.3390\/nu15234897"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8135\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:20:53Z","timestamp":1763558453000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":50,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14228135"],"URL":"https:\/\/doi.org\/10.3390\/jcm14228135","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,17]]}}}