Gestational diabetes mellitus and life insurance: what is the impact of gestational diabetes mellitus on life insurance premiums?

The diagnosis, management, and implications of gestational diabetes mellitus (GDM) remain areas of controversy. The International Association of the Diabetes and Pregnancy Study Groups (1) suggested new diagnostic criteria based on the results of the Hyperglycemia and Adverse Pregnancy Outcome Study (2). These criteria have been adopted by the World Health Organization (3), but the National Institutes of Health decided there was inadequate evidence for change and has remained with the status quo (4). A commentary by Ryan in Diabetes Care, among other things, stated that a diagnosis of GDM is “. . . a medical label of high risk for the future that will influence the mother’s insurance premiums in most U.S. states” (5). While the type of insurance was not specified, one aspect of this could be access to life and disability insurance. It is important that the debate about GDM is based on facts and not supposition. We have made a preliminary start on the insurance issue by reviewing the underwriting approach taken by companies in Australia that have the major market share of newly written life and disability policies. Twelve companies were identified and, with the assistanceofAustralasian LifeUnderwriting and Claims Association Inc., were electronically surveyed. Responses were obtained from 10 companies (83%) with an estimated market share of more than 94% of the retail life insurance new business that is written. All companies responded that they would take into account a history of GDM and this information should be disclosed on an application for insurance. The following scenario was proposed: “Your Company is approached by a professional woman (sedentary occupation, employed) with an enquiry about Life Insurance and Disability Income Protection Insurance to age 65 with a 30 day waiting period. She is aged 40, no adverse alcohol habits, a lifelong non-smoker, no adverse family history, currently taking no medications, has a BMI of 25 and has had no past health problems apart from gestational diabetes during her second pregnancy 10 years ago. An oral GTT performed 7 weeks after this pregnancy was normal and subsequent blood sugar tests have also been normal. She is not currently pregnant.” All companies responded that she would qualify for the abovementioned life and disability insurance policies at standard ratesdno additional premium would be charged. Without other health risk factors, that by themselves may be responsible for additional premiums, a previous diagnosis of GDM does not pose a financial impediment to life and disability insurance in Australia. In different countries, there will be different types of insurances, and clearly, more precise and more local specific data will be required. Until these data are obtained, the argument that a diagnosis of GDM may compromise insurance cannot be supported. We therefore encourage similar studies in other countries.