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Lovett SM, Woo JMP, O'Brien KM, Parker SE, Sandler DP. Association of Early-life Trauma With Gestational Diabetes and Hypertensive Disorders of Pregnancy. Epidemiology 2025; 36:149-159. [PMID: 39739403 DOI: 10.1097/ede.0000000000001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
BACKGROUND Early-life trauma (before age of 18 years) is hypothesized to increase the risk for adverse pregnancy outcomes through stress pathways, yet epidemiologic findings are mixed. METHODS Sister Study participants (US women aged 35-74 years enrolled 2003-2009) completed an adapted Brief Betrayal Trauma Survey at the first follow-up visit. Lifetime history of gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP: pregnancy-related high blood pressure, pre-eclampsia/toxemia, or eclampsia) in pregnancies lasting ≥20 weeks was self-reported. We used log-binomial regression to estimate relative risks (RR) and 95% confidence intervals (CIs) for the association between early-life trauma (modeled using conventional measures [e.g., any experience, substantive domains, individual types] and latent classes of co-occurring traumas) and GDM or HDP among 34,879 parous women. RESULTS Approximately, 4% of participants reported GDM and 11% reported HDP. Relative to no early-life trauma, the RRs for any were 1.1 (95% CI = 1.0, 1.3) for GDM and 1.2 (95% CI = 1.2, 1.3) for HDP. Women reporting physical trauma had the highest risk of GDM and HDP in comparison to other substantive domains. In analyses using latent classes of early-life trauma, high trauma was associated with an elevated risk of both GDM (RR = 1.9, 95% CI = 1.5, 2.6) and HDP (RR = 1.7, 95% CI = 1.4, 2.0) compared with low trauma. CONCLUSIONS Women experiencing high levels of trauma in early life were at higher risk of GDM and HDP, adding to a growing evidence base for this association.
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Affiliation(s)
- Sharonda M Lovett
- From the Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Samantha E Parker
- From the Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
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Sasaki N, Pang J, Surdu S, Shirey S, Fernando T, Moore J. Use of oral health services among pregnant women and associations with gestational diabetes and hypertensive disorders of pregnancy: Insights from the 2016-2020 Pregnancy Risk Assessment Monitoring System. J Am Dent Assoc 2025; 156:185-197.e2. [PMID: 39891653 DOI: 10.1016/j.adaj.2024.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 10/04/2024] [Accepted: 11/24/2024] [Indexed: 02/03/2025]
Abstract
BACKGROUND The authors examined whether use of preventive oral health care services or visits to a dentist or dental clinic for problems during pregnancy is associated with gestational diabetes and hypertensive disorders of pregnancy. METHODS Data from the 2016-2020 Pregnancy Risk Assessment Monitoring System, comprising 206,080 unweighted responses, were analyzed using descriptive statistics and multivariable logistic regression. The regression estimates were adjusted for sociodemographic and lifestyle characteristics, health history, geography, and survey year. RESULTS Women who received a diagnosis of gestational diabetes (7.0%) or hypertensive disorders of pregnancy (13.3%) had lower rates of preventive oral health care and visits to a dentist or dental clinic for problems during pregnancy than those who did not have these health outcomes. Women who did not receive preventive oral health care had 1.13-fold greater odds (95% CI, 1.06 to 1.20) of having gestational diabetes and 1.08-fold greater odds (95% CI, 1.03 to 1.13) of having hypertensive disorders of pregnancy than those who did. Lack of needed visits to a dentist or dental clinic during pregnancy was associated with 1.28-fold greater odds (95% CI, 1.13 to 1.44) of having hypertensive disorders of pregnancy than in women without dental problems. CONCLUSIONS Using oral health care preventive services and visits to a dentist or dental clinic for problems during pregnancy was associated with decreased odds of having gestational diabetes and hypertensive disorders of pregnancy. PRACTICAL IMPLICATIONS Health care professionals should emphasize the importance of obtaining oral health care services to promote oral and overall health among pregnant women. Dentists need to improve their knowledge and willingness to treat pregnant women, especially those with pregnancy complications.
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Mu Y, Huang J, Yang J, Zuo H, Monami M, Cristina do Vale Moreira N, Hussain A. Ethnic differences in the effects of lifestyle interventions on adverse pregnancy outcomes among women with gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract 2024; 217:111875. [PMID: 39349252 DOI: 10.1016/j.diabres.2024.111875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/24/2024] [Accepted: 09/26/2024] [Indexed: 10/02/2024]
Abstract
AIMS Lifestyle interventions are widely used among women with gestational diabetes mellitus (GDM). This study aimed to assess the ethnic disparities in the effectiveness of lifestyle interventions on reducing adverse pregnancy outcomes, particularly macrosomia and neonatal hypoglycemia among women with GDM. METHODS We systematically searched the PubMed/MEDLINE, Web of Science, and Cochrane Library databases from January 1, 2000, up to March 31, 2024, to identify randomized controlled trials (RCTs) examining the effects of lifestyle interventions in GDM patients. Subgroup analysis was performed to investigate heterogeneity across different ethnic groups (including Asians, Whites/Caucasians, Hispanics/ Latinos, and Unknown ethnicity). The random effects model was used to calculate the relative risk (RR) and 95% confidence interval (CI). RESULTS After applying inclusion and exclusion criteria, twenty-one studies comprising 4567 participants were included. Lifestyle interventions significantly reduced the incidence of macrosomia ((RR = 0.54; 95 % CI: 0.42-0.70, P < 0.001), with consistent effects observed across racial groups. Conversely, lifestyle interventions were associated with a significant reduction in the risk of neonatal hypoglycemia only among Asians (RR = 0.56; 95 % CI: 0.38-0.84, P = 0.004), while no significant effects were observed in Whites/Caucasians or Hispanics/Latinos (all P > 0.05). Sensitivity analyses confirmed the robustness of the findings. CONCLUSIONS Regardless of ethnic background, this study emphasizes the significant benefits of lifestyle interventions in reducing the risk of macrosomia among women with GDM. However, lifestyle interventions seem to reduce the risk of neonatal hypoglycemia only among Asians, which warrants further studies.
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Affiliation(s)
- Yingjun Mu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Junyao Huang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jie Yang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-Communicable Diseases, Suzhou Medical College of Soochow University, Suzhou, China; MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Matteo Monami
- Unit of Diabetology and Metabolic Diseases, Careggi Teaching Hospital, Florence, Italy
| | | | - Akhtar Hussain
- Faculty of Health Sciences, NORD University, Bodø, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation, 166 Chaussee de La Hulpe B-1170, Brussels, Belgium
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Hunt KJ, Wen CC, Neelon B, Wilson DA, Mateus J, Pearce J, Chundru K, Simpson S, Korte JE, Florez H, Malek AM. Increasing Prevalence of Diagnosed Gestational Diabetes in South Carolina: 2015-2021. J Womens Health (Larchmt) 2024; 33:1518-1527. [PMID: 39229709 PMCID: PMC11698680 DOI: 10.1089/jwh.2023.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
Objective: To examine trends with a focus on racial and ethnic disparities in reported gestational diabetes mellitus (GDM) and related outcomes (macrosomia, large for gestational age infants) before and during the COVID-19 pandemic in South Carolina (SC). Methods: A retrospective cohort study of pregnancies resulting in livebirths from 2015 through 2021 was conducted in SC. Statewide maternal hospital and emergency department discharge codes were linked to birth certificate data. GDM was defined by ICD-9-CM (i.e., 648.01-648.02, 648.81-648.82) or ICD-10-CM codes (i.e., O24.4, O24.1, O24.9), or indication of GDM on the birth certificate without evidence of diabetes outside pregnancy (ICD-9-CM: 250.xx; ICD-10-CM: E10, E11, O24.0, O24.1, O24.3). Results: Our study included 194,777 non-Hispanic White (White), 108,165 non-Hispanic Black (Black), 25,556 Hispanic, and 16,344 other race-ethnic group pregnancies. The relative risk for GDM associated with a 1-year increase was 1.01 (95% confidence interval [CI]: 1.01-1.02) before the pandemic and 1.12 (1.09-1.14) during the pandemic. While there were race-ethnic differences in the prevalence of GDM, increasing trends were similar across all race-ethnic groups before and during the pandemic. From quarter 1, 2020, to quarter 4, 2021, the prevalence of reported GDM increased from 8.92% to 10.85% in White, from 8.04% to 9.78% in Black, from 11.2% to 13.65% in Hispanic, and from 13.3% to 16.16% in other race-ethnic women. Conclusion: An increasing prevalence of diagnosed GDM was reported during the COVID-19 pandemic. Future studies are needed to understand the mechanisms underlying increasing trends, to develop interventions, and to determine whether the increasing trend continues in subsequent years.
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Affiliation(s)
- Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Chun-Che Wen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Dulaney A. Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julio Mateus
- Maternal-Fetal Medicine Division, Department of Obstetrics & Gynecology, Atrium Health, Charlotte, North Carolina, USA
| | - John Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kalyan Chundru
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah Simpson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey E. Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hermes Florez
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Pan Q, Yang Y, Cao H, Xu Z, Tian Z, Zhan Y, Li Z, Lu M, Gu F, Lu Q, Gong L, Liu H, Li Y, Lu J, Chen Z. Contribution of Insulin Resistance and β Cell Dysfunction to Gestational Diabetes Stratified for Pre-pregnant Body Mass Index. Reprod Sci 2024; 31:1151-1158. [PMID: 37957467 DOI: 10.1007/s43032-023-01379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
The objective of the study was to evaluate the contribution of insulin resistance and β cell dysfunction to gestational diabetes mellitus (GDM) in Chinese women stratified by pre-pregnant body mass index (BMI). A total of 847 pregnant women were enrolled. They were divided into low BMI and high BMI groups according to the median of pre-pregnancy BMI. The homeostasis model assessment of insulin resistance (HOMA-IR) and β cell function (HOMA-β), Matsuda index, and 60-min insulinogenic index (IGI60) were used to evaluate insulin resistance and β cell function. In all the participants, 150 (17.71%) were diagnosed with GDM. ROC analyses showed that in the low BMI group, the association of β cell dysfunction (IGI60 or HOMA-β) with GDM was stronger than that of insulin resistance (Matsuda index or HOMA-IR), while in the high BMI group, the association of β cell dysfunction with GDM was weaker than that of insulin resistance (all P < 0.05). Among all GDM patients, 47.33% demonstrated predominant insulin resistance (Matsuda index < 25th percentile), and 46% had predominant β cell defect (IGI60 < 25th percentile). In the low BMI group, 15.09% of GDM patients demonstrated predominant insulin resistance, and 62.26% of GDM patients had predominant β cell defect, whereas in the high BMI group, 64.95% of GDM patients demonstrated mainly insulin resistance and 36.08% of GDM patients had mainly β cell defect. In women with low BMI, β cell dysfunction is the major etiologic factor, whereas, in women with high BMI, insulin resistance is the predominant etiologic factor in the development of GDM.
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Affiliation(s)
- Qingrong Pan
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yanna Yang
- Department of General Practice, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Emergency, Beijing Electric Power Hospital, Capital Medical University, Beijing, China
| | - Huawei Cao
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zibo Xu
- Department of Education, Second College of Clinical Medicine, Tianjin Medical University, Tianjin, China
| | - Zeyang Tian
- Department of General Practice, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of General Practice, Binhe Street Community Health Service Center, Pinggu District, Beijing, China
| | - Yuanyuan Zhan
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Zhan Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Menghan Lu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Fang Gu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qi Lu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Liyun Gong
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Hao Liu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yanfang Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Junli Lu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Zhe Chen
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
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Walker C, Begum T, Boyle JA, Ward J, Barzi F. Preconception Health of Indigenous Peoples in Australia, Canada, New Zealand, and the United States: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:345. [PMID: 38541344 PMCID: PMC10969840 DOI: 10.3390/ijerph21030345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND There is increasing recognition of the importance of the preconception period for addressing reproductive and intergenerational health inequities and supporting improved maternal and child health outcomes. This study aimed to understand the extent and type of evidence that exists in relation to preconception health for Indigenous peoples living in high-income countries with similar experiences of colonisation, namely, Australia, New Zealand, Canada, and the United States. METHODS This review was conducted as per the JBI methodology and PRISMA Extension for Scoping Reviews. A comprehensive search of PubMed, CINAHL [EBSCO], Ovid Embase, Scopus, and the Wiley Cochrane Library was conducted using keywords and index terms. We included research in English published between January 2010 and June 2023 on quantitative and qualitative primary studies. Data were extracted using a standardised tool, and the analysis included quantitative descriptions and qualitative content analysis. RESULTS We identified 360 potential studies and included 57 articles in the review. Most studies were from the United States (n = 36, 63.2%) and Australia (n = 13, 22.8%), and they commonly reported associations between preconception health risk factors and maternal or child health outcomes (n = 27, 48.2%) or described the development, implementation, or evaluation of preconception health interventions (n = 26, 46.4%). Common preconception health areas were pre-pregnancy body mass index or weight (n = 34), alcohol (n = 16), diet (n = 14), physical activity (n = 12), and diabetes (n = 11). Most studies focused exclusively on women (n = 46, 80.7%), and very few included men (n = 3, 5.3%). The study populations were mostly urban and rural (n = 25, 43.9%) or rural only (n = 14, 24.6%); however, the geographical remoteness was often unclear (n = 14, 24.6%). CONCLUSIONS While there was some research relating to the preconception health of Indigenous peoples, this review identified considerable research gaps. There is a need for dedicated research into preconception health risk factors and reproductive health outcomes, attitudes and awareness of preconception health, and preconception health interventions for Indigenous peoples.
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Affiliation(s)
- Clara Walker
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Tahmina Begum
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
| | - Jacqueline A Boyle
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
| | - Federica Barzi
- UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
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Sadiq R, Bukhari MH, Brown TT, Bennett WL, Retnakaran R, Echouffo-Tcheugui JB. Association of cumulative social risk and gestational diabetes mellitus in the US, 2007-2018. Diabetes Res Clin Pract 2023; 203:110840. [PMID: 37482220 PMCID: PMC10592126 DOI: 10.1016/j.diabres.2023.110840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/03/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
AIMS Little is known regarding the association of multiple social risk factors and gestational diabetes mellitus (GDM). METHODS We analyzed the 2007-2018 National Health and Nutrition Examination Surveys including 10,439 women aged ≥20 years (8 % with history of GDM). We created a cumulative social risk score (CSR) by adding scores assigned to each of the following: race/ethnicity, citizenship status and country of birth, education, and family income (score of 0 used as reference group). Using logistic regression, we assessed the associations of individual social risk factors (education, income, race/ethnicity and citizenship status) and CSR score with GDM, adjusting for age, parity, insurance status, care access, smoking, diet, physical activity, and body mass index. RESULTS Among individual social risk factors, being a non-U.S. citizen (OR:1.51, 95% CI: 1.06-2.15) or belonging to a minority racial/ethnic group (OR:1.30, 95% CI: 1.04-1.59) was significantly associated with a greater odds of GDM. When examining the combined effects of social risk factors, a CSR score ≥3 was associated with an increased odds of GDM (OR:1.64, 95% CI: 1.22-2.1). CONCLUSIONS Women with a greater burden of social risk factors are more likely to have GDM, thus should be the focus of interventions to prevent and treat GDM.
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Affiliation(s)
- Rabail Sadiq
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Muhammad H Bukhari
- Department of Medicine, Norwalk Hospital affiliated with Yale University School of Medicine, Norwalk, CT, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Spinelli P, Fields AM, Falcone S, Mesaros C, Susiarjo M. Susceptibility to Low Vitamin B6 Diet-induced Gestational Diabetes Is Modulated by Strain Differences in Mice. Endocrinology 2023; 164:bqad130. [PMID: 37624591 PMCID: PMC10686696 DOI: 10.1210/endocr/bqad130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
Gestational diabetes is a common pregnancy complication that adversely influences the health and survival of mother and child. Pancreatic islet serotonin signaling plays an important role in β-cell proliferation in pregnancy, and environmental and genetic factors that disrupt serotonin signaling are associated with gestational diabetes in mice. Our previous studies show that pregnant C57BL/6J mice fed a diet that is low in vitamin B6, a critical co-factor in serotonin synthesis, develop hyperglycemia and glucose intolerance, phenotypes that are consistent with gestational diabetes in humans. The current study shows that, unlike in the C57BL/6J mice, low vitamin B6 diet does not alter glucose tolerance and insulin secretion in pregnant DBA/2J mice. The hypothesis to be tested in the current study is that pregnant DBA/2J mice are protected against low vitamin B6-induced gestational diabetes due to their higher expression and enzymatic activities of tissue nonspecific alkaline phosphatase (ALPL) relative to C57BL/6J. ALPL is a rate-limiting enzyme that regulates vitamin B6 bioavailability. Interestingly, treating pregnant DBA/2J mice with 7.5 mg/kg/day of the ALPL inhibitor SBI-425 is associated with glucose intolerance in low vitamin B6-fed mice, implying that inhibition of ALPL activity is sufficient to modulate resilience to low vitamin B6-induced metabolic impairment.
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Affiliation(s)
- Philip Spinelli
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Ashley M Fields
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Sierra Falcone
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Clementina Mesaros
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Martha Susiarjo
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Jatavan P, Luewan S, Sirilert S, Tongsong T. Trends in the Prevalence of Diabetes Mellitus in Pregnancy during the Past Two Decades in Northern Thailand. Healthcare (Basel) 2023; 11:healthcare11091315. [PMID: 37174857 PMCID: PMC10177818 DOI: 10.3390/healthcare11091315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
Background: The prevalence of gestational diabetes mellitus (GDM) and pre-gestational diabetes mellitus (PDM) has increased dramatically in the past decade in all ethnic groups. The prevalence also varies markedly among different ethnic groups. Each ethnic group must have its own data about GDM/PDM for improvement in women's health care. We conducted this study with the main objective of assessing recent trends in the prevalence of PDM/GDM among pregnant women in the northern part of Thailand during the past two decades. The secondary objective is to identify the risk factors influencing the prevalence of DM in pregnancies. Patients and Methods: The maternal-fetal medicine database was accessed to retrieve consecutive obstetric records of women who gave birth in Chiang Mai University Hospital, Thailand, from January 2003 to December 2022. This is a 20-year study period of the same protocol of GDM screening policy, using the 50 g glucose challenge test as a screening test for the average risk group and the 100 g OGTT as a diagnostic test. The women were categorized into GDM, PDM and non-DM groups. Trends or percentage changes in the prevalence of GDM/PDM during the study period were evaluated. Risk factors related to GDM/PDM were identified. Results: Among 37,027 women who gave birth during the study period, the prevalence of DM in pregnancy was 11.4% (4223 cases), including 214 cases of PDM (0.6%) and 4009 cases of GDM (10.8%). The prevalence of PDM significantly increased from 0.3% in 2003 to 1.5% in 2022; also, the prevalence of GDM significantly increased, dramatically, from 3.4% in 2003 to 22.0% in 2022. The prevalence of GDM increased in recent years in all age groups (adolescent, reproductive and elderly groups), while that of PDM did not significantly change in the adolescent group during the study period. Maternal age and pre-pregnancy BMI significantly increased in the more recent years. Independent factors significantly associated with the prevalence of PDM/GDM include maternal age, pre-pregnancy BMI, higher socio-economic status, and urban areas of residence. Recent time is still an independent risk factor after adjustment for other known factors. Conclusions: Relatively, GDM and PDM are highly prevalent in the northern part of Thailand, and their prevalence continuously increased during the past two decades. The trend of increased prevalence was evident in all age groups. Increasing maternal age and pre-pregnancy BMI mainly contributed to the increase in the prevalence of GDM and PDM in recent years. Recent time is still an independent risk factor after adjustment for other known factors, indicating that some other unexplained risk factors are associated with the increase in prevalence of DM in recent years, possibly the increase in sedentary lifestyle. Modification of lifestyle, especially reducing pre-pregnancy BMI among reproductive women, may reduce the prevalence of DM in pregnancy.
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Affiliation(s)
- Phudit Jatavan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suchaya Luewan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sirinart Sirilert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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10
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Exploring Health Care Disparities in Maternal-Child Simulation-Based Education. Nurs Educ Perspect 2023; 44:87-91. [PMID: 36730772 DOI: 10.1097/01.nep.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM The purpose of this study was to explore student experiences within a health care disparity simulation, embedded in maternal-child content. BACKGROUND Health care disparities related to race and ethnicity in the maternal-child population are daunting among African American and Hispanic women. METHOD Participants completed the Simulation Effectiveness Tool-Modified, a rapid-fire huddle questionnaire, and a demographic instrument. All students participated in structured debriefing. RESULTS Student responses ( n = 69) demonstrated effectiveness in learning via this scenario. CONCLUSION The rapid-fire huddle and debriefing are important elements when health care disparities are introduced into nursing curricula.
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11
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Burns A, DeAtley T, Short SE. The maternal health of American Indian and Alaska Native people: A scoping review. Soc Sci Med 2023; 317:115584. [PMID: 36521232 PMCID: PMC9875554 DOI: 10.1016/j.socscimed.2022.115584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022]
Abstract
Indigenous people in the United States experience disadvantage in multiple domains of health. Yet, their maternal health receives limited research attention. With a focus on empirical research findings, we conduct a scoping review to address two questions: 1) what does the literature tell us about the patterns and prevalence of maternal mortality and morbidity of American Indian and Alaska Native (AI/AN) people? and 2) how do existing studies explain these patterns? A search of CINAHL, Embase and Medline yielded 4757 English-language articles, with 66 eligible for close review. Of these, few focused specifically on AI/AN people's maternal health. AI/AN people experience higher levels of maternal mortality and morbidity than non-Hispanic White people, with estimates that vary substantially across samples and geography. Explanations for the maternal health of AI/AN people focused on individual factors such as poverty, cultural beliefs, and access to healthcare (e.g. lack of insurance). Studies rarely addressed the varied historical and structural contexts of AI/AN tribal nations, such as harms associated with colonization and economic marginalization. Research for and by Indigenous communities and nations is needed to redress the effective erasure of AI/AN people's maternal health experiences and to advance solutions that will promote their health and well-being.
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Affiliation(s)
- Ailish Burns
- Department of Sociology, Brown University, 108 George St Box 1916, Providence RI, 02912, USA; Population Studies and Training Center, Brown University, 68 Waterman St Box 1836, Providence RI, 02912, USA.
| | - Teresa DeAtley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Susan E Short
- Department of Sociology, Brown University, 108 George St Box 1916, Providence RI, 02912, USA; Population Studies and Training Center, Brown University, 68 Waterman St Box 1836, Providence RI, 02912, USA
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12
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Flores-LE Roux JA, Mañé L, Gabara C, Gortazar L, Pedro-Botet J, Chillarón JJ, Pay À A, Benaiges D. Ethnic differences in the impact of gestational diabetes on macrosomia. Minerva Endocrinol (Torino) 2022; 47:403-412. [PMID: 33435645 DOI: 10.23736/s2724-6507.20.03301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous studies reported an ethnic disparity in gestational diabetes mellitus-associated birth outcomes, with some suggesting that macrosomia increases to a lesser extent in groups at high risk, the opposite of the pattern observed by others. Our aim was to evaluate ethnic variation in the impact of gestational diabetes mellitus (GDM). METHODS A case-control study evaluating pregnancy outcomes was conducted in women with and without GDM from five ethnic groups. Data on GDM were collected between January 2004 and July 2017. Women giving birth between May 2013 and July 2017 in whom pre-existing diabetes had been ruled out served as controls. A multivariate logistic regression analysis was performed to determine factors independently associated with macrosomia. RESULTS Overall, 852 GDM women and 3,803 controls were included. In Caucasian and East-Asian women excessive gestational weight gain (OR 2.273, 95% CI 1.364-3.788 and OR 3.776, 95% CI 0.958-14.886) was an independent predictor of macrosomia. In Latin-American and Moroccan women, obesity (OR 1.774, 95% CI 1.219-2.581 and OR 1.656, 95% CI 1.054-2.601), GDM (OR 2.440; 95% CI 1.048-5.679 and OR 3.249, 95% CI 1.269-8.321) and gestational weight gain but only for Latin-American women (OR 2.365, 95% CI 1.039-5.384) were associated with macrosomia. In South-Central Asian women, only GDM was associated with macrosomia (OR 3.701, 95% CI 1.437-9.532). CONCLUSIONS GDM is an independent predictor of macrosomia in Latin-American, South-Central Asian and Moroccan women but not in Caucasian or East-Asian women in whom other factors play a more important role.
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Affiliation(s)
- Juana A Flores-LE Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain - .,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain -
| | - Laura Mañé
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Gabara
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Lucia Gortazar
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Pay À
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Department of Gynecology and Obstetrics, Hospital del Mar, Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Kawamura MY, Mau MK, Soon R, Yamasato K. A Scoping Review on Gestational Diabetes in Hawai'i: A "Window of Opportunity" to Address Intergenerational Risk for Type 2 Diabetes Mellitus. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:58-70. [PMID: 35261986 PMCID: PMC8899083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The health of women over the entire span of their reproductive years is crucial - beginning in adolescence and extending through the postpartum period. This paper provides a scoping review of the relevant literature on risk factors for gestational diabetes mellitus (GDM) and progression from GDM to type 2 diabetes mellitus (T2DM), particularly among women of Native Hawaiian and Pacific Islander (NHPI) and Asian racial/ethnic backgrounds in Hawai'i, using the PubMed database (July 2010 to July 2020). NHPI and Asian populations have a greater likelihood of developing GDM compared to their White counterparts. Risk factors such as advanced maternal age, high maternal body mass index, and lack of education about GDM have varying levels of impact on GDM diagnosis between ethnic populations. Mothers who have a history of GDM are also at higher risk of developing T2DM. Common risk factors include greater increase in postpartum body mass index and use of diabetes medications during pregnancy. However, few studies investigate the progression from GDM to T2DM in Hawai'i's Asian and NHPI populations, and no studies present upstream preconception care programs to prevent an initial GDM diagnosis among Hawai'i's women. Thus, updated reports are necessary for optimal early interventions to prevent the onset of GDM and break the intergenerational cycle of increased susceptibility to T2DM and GDM in both mother and child. Further attention to the development of culturally sensitive interventions may reduce disparities in GDM and improve the health for all affected by this condition.
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Affiliation(s)
- Megan Y. Kawamura
- Department of Native Hawaiian Health Summer 2020 Research Intern, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Marjorie K. Mau
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Reni Soon
- Department of Obstetrics, Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Kelly Yamasato
- Department of Obstetrics, Gynecology and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
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14
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Suss R, Mahoney M, Arslanian KJ, Nyhan K, Hawley NL. Pregnancy health and perinatal outcomes among Pacific Islander women in the United States and US Affiliated Pacific Islands: Protocol for a scoping review. PLoS One 2022; 17:e0262010. [PMID: 35041684 PMCID: PMC8765672 DOI: 10.1371/journal.pone.0262010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
This scoping review examines the literature on pregnancy and perinatal outcomes among Pacific Islander women in the United States (U.S.) and U.S.-affiliated Pacific Islands. Our aim was to identify research that disaggregated Pacific Islanders from other population groups. We conducted a systematic search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid) databases and a hand-search of grey literature. Forty-eight articles published between January 2010 and June 2020 were included. The majority of studies were conducted in Hawaii and utilized clinical record data. Infant outcomes were more commonly reported than maternal outcomes. We highlighted several limitations of the existing literature that included aggregation of Pacific Islanders with Asian American and other ethnic groups; limited comparison between Pacific Islander sub-groups; inadequate definitions of the nationality and ethnic composition of Pacific Islander groups; a lack of hypothesis-driven primary data collection and clinical trials; and underrepresentation of Pacific Islanders in population-based studies. Researchers should address these limitations to improve pregnancy and perinatal outcomes among Pacific Islanders, who comprise the second fastest growing ethnic minority in the U.S.
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Affiliation(s)
- Rachel Suss
- Yale College, Yale University, New Haven, CT, United States of America
| | - Madison Mahoney
- Yale College, Yale University, New Haven, CT, United States of America
| | - Kendall J. Arslanian
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States of America
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
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15
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Shankar M, Chan CS, Frayne SM, Panelli DM, Phibbs CS, Shaw JG. Postpartum Transition of Care: Racial/Ethnic Gaps in Veterans' Re-Engagement in VA Primary Care after Pregnancy. Womens Health Issues 2021; 31:603-609. [PMID: 34229932 DOI: 10.1016/j.whi.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pregnancy presents an opportunity to engage veterans in health care. Guidelines recommend primary care follow-up in the year postpartum, but loss to follow-up is common, poorly quantified, and especially important for those with gestational diabetes (GDM) and hypertension. Racial maternal inequities are well-documented and might be exacerbated by differential postpartum care. This study explores variation in postpartum re-engagement in U.S. Department of Veteran Affairs health care system (VA) primary care to identify potential racial/ethnic inequities in this care transition. METHODS We conducted a complete case analysis of the 2005-2014 national VA birth cohort (n = 18,414), and subcohorts of veterans with GDM (n = 1,253), and hypertensive disorders of pregnancy (HDP; n = 2,052) using VA-reimbursed discharge claims and outpatient data. Outcomes included incidence of any VA primary care visit in the postpartum year; in age-adjusted logistic regression, we explored race/ethnicity as a primary predictor. RESULTS In the year after a VA-covered birth, the proportion of veterans with one or more primary care visit was 53.8% overall, and slightly higher in the GDM (56.0%) and HDP (57.4%) subcohorts. In adjusted models, the odds of VA primary care follow-up were significantly lower for Black/African American (odds ratio, 0.87; 95% confidence interval, 0.81-0.93), Asian (odds ratio, 0.76; 95% confidence interval, 0.61-0.95), and Hawaiian/other Pacific Islander (odds ratio, 0.73; 95% confidence interval, 0.55-0.96) veterans, compared with White veterans. Among the subcohorts with GDM or HDP, there were no significant associations between primary care and race/ethnicity. CONCLUSIONS One-half of veterans re-engage in VA primary care after childbirth, with significant racial differences in this care transition. Re-engagement for those with the common pregnancy complications of HDP and GDM is only slightly higher, and less than 60%. The potential for innovations like VA maternity care coordinators to address such gaps merits attention.
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Affiliation(s)
- Megha Shankar
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Policy (CHP), Stanford, California
| | - Caitlin S Chan
- Health Economics Research Center and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Policy (CHP), Stanford, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Danielle M Panelli
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Palo Alto, California
| | - Ciaran S Phibbs
- Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Policy (CHP), Stanford, California; Health Economics Research Center and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan G Shaw
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Policy (CHP), Stanford, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California.
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16
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Williams AD, Ha S, Shenassa E, Messer LC, Kanner J, Mendola P. Joint effects of ethnic enclave residence and ambient volatile organic compounds exposure on risk of gestational diabetes mellitus among Asian/Pacific Islander women in the United States. Environ Health 2021; 20:56. [PMID: 33964949 PMCID: PMC8106843 DOI: 10.1186/s12940-021-00738-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/26/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Asian/Pacific Islander (API) communities in the United States often reside in metropolitan areas with distinct social and environmental attributes. Residence in an ethnic enclave, a socially distinct area, is associated with lower gestational diabetes mellitus (GDM) risk, yet exposure to high levels of air pollution, including volatile organic compounds (VOCS), is associated with increased GDM risk. We examined the joint effects of ethnic enclaves and VOCs to better understand GDM risk among API women, the group with the highest prevalence of GDM. METHODS We examined 9069 API births in the Consortium on Safe Labor (19 hospitals, 2002-2008). API ethnic enclaves were defined as areas ≥66th percentile for percent API residents, dissimilarity (geographic dispersal of API and White residents), and isolation (degree that API individuals interact with another API individual). High levels of 14 volatile organic compounds (VOC) were defined as ≥75th percentile. Four joint categories were created for each VOC: Low VOC/Enclave (reference group), Low VOC/No Enclave, High VOC/Enclave, High VOC/No Enclave. GDM was reported in medical records. Hierarchical logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) between joint exposures and GDM, adjusted for maternal factors and area-level poverty. Risk was estimated for 3-months preconception and first trimester exposures. RESULTS Enclave residence was associated with lower GDM risk regardless of VOC exposure. Preconception benzene exposure was associated with increased risk when women resided outside enclaves [High VOC/No Enclave (OR:3.45, 95%CI:1.77,6.72)], and the effect was somewhat mitigated within enclaves, [High VOC/Enclave (OR:2.07, 95%:1.09,3.94)]. Risks were similar for 12 of 14 VOCs during preconception and 10 of 14 during the first trimester. CONCLUSIONS API residence in non-enclave areas is associated with higher GDM risk, regardless of VOC level. Ethnic enclave residence may mitigate effects of VOC exposure, perhaps due to lower stress levels. The potential benefit of ethnic enclaves warrants further study.
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Affiliation(s)
- Andrew D. Williams
- Public Health program, Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Room E162, 1301 North Columbia Road Stop 9037, Grand Forks, ND 58202-9037 USA
| | - Sandie Ha
- School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N. Lake Road, Merced, CA USA
| | - Edmond Shenassa
- Maternal and Child Health Program, Department of Family Science, University of Maryland College Park, 4200 Valley Drive, College Park, MD USA
| | - Lynne C. Messer
- OHSU-PSU School of Public Health, Portland State University, 506 SW Mill Street 470H, Portland, OR USA
| | - Jenna Kanner
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC, Bethesda, MD 7004 USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC, Bethesda, MD 7004 USA
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17
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Kunasegaran T, Balasubramaniam VRMT, Arasoo VJT, Palanisamy UD, Ramadas A. Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1272. [PMID: 33572656 PMCID: PMC7908368 DOI: 10.3390/ijerph18031272] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute's methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.
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Affiliation(s)
| | | | | | | | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (T.K.); (V.R.M.T.B.); (V.J.T.A.); (U.D.P.)
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18
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Wang P, Wu CS, Li CY, Yang CP, Lu MC. Seasonality of gestational diabetes mellitus and maternal blood glucose levels: Evidence from Taiwan. Medicine (Baltimore) 2020; 99:e22684. [PMID: 33031338 PMCID: PMC7544315 DOI: 10.1097/md.0000000000022684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Previous studies have indicated that the prevalence of gestational diabetes mellitus (GDM) was related to the season. However, there was no relevant information in Asia. The aim of this study was to determine whether there was seasonality of GDM and maternal blood glucose level in Taiwanese women.A total of 6396 pregnancies were enrolled between 2012 and 2014 in this retrospective study. A 2-step approach according to the Carpenter-Coustan criteria was used for GDM diagnosis. A generalized linear mixed model was used to estimate the effect of season on GDM diagnosis by adjusting for age, prepregnancy body mass index, parity, history of GDM, fetal sex, and the rate of weight gain.During the study period, 418 (6.5%) pregnancies were diagnosed as GDM. The model demonstrated an increased prevalence of GDM in spring and summer (odds ratio: 1.59, 95% confidence interval: 1.13-2.24; odds ratio: 1.59, 95% confidence interval: 1.14-2.23, respectively) compared to winter. For the glucose level variation, the model demonstrated an increase of 2.56 mg/dL glucose in the 50-g glucose challenge test in summer compared to winter. In glucose challenge test-positive pregnancies, the season also had an effect on the results of the 100-g 1-h, 2-h, and 3-h oral glucose tolerance tests, but no effect on the 100-g fasting oral glucose tolerance tests.GDM prevalence in Taiwan presents seasonal variation, with the highest risk during spring and summer due to post-glucose load level variations. These findings could serve as reference data for countries in Southeast Asia or areas with a similar climate.
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Affiliation(s)
- Panchalli Wang
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi
| | - Chung-Shing Wu
- Department of Family Medicine, Kuang-Tien General hospital, Taichung
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan
- Department of Public Health, College of Public Health, China Medical University
| | - Chun-Pai Yang
- Department of Neurology
- Department of Medical Research, Kuang Tien General Hospital
- Department of Nutrition and Institute of Biomedical Nutrition, Hung Kuang University, Taichung
| | - Mei-Chun Lu
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Taiwan
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Voaklander B, Rowe S, Sanni O, Campbell S, Eurich D, Ospina MB. Prevalence of diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand, and the USA: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2020; 8:e681-e698. [DOI: 10.1016/s2214-109x(20)30046-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/28/2020] [Accepted: 02/05/2020] [Indexed: 12/19/2022]
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Kragelund Nielsen K, Andersen GS, Damm P, Andersen AMN. Gestational Diabetes Risk in Migrants. A Nationwide, Register-Based Study of all Births in Denmark 2004 to 2015. J Clin Endocrinol Metab 2020; 105:5707566. [PMID: 31950143 DOI: 10.1210/clinem/dgaa024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Much remains to be understood about socioeconomic position and body mass index (BMI) in the pathways linking ethnicity, migration, and gestational diabetes mellitus (GDM). We investigated differences in GDM prevalence according to maternal country of origin and the role played by socioeconomic position and BMI on this relationship. Finally, we examined how length of residency was associated with GDM. METHODS A register-based cohort study of the 725 482 pregnancies that resulted in a birth in Denmark, 2004 to 2015. Of these, 14.4% were by women who had migrated to Denmark. A GDM diagnosis was registered in 19 386 (2.7%) pregnancies, of which 4464 (23.0%) were in immigrant women. The crude risk of GDM according to maternal country of origin compared to Danish-born women ranged from an odds ratio (OR) of 0.50 (95% CI 0.34-0.71) for women from Sweden to an OR of 5.11 (95% CI 4.28-6.11) for women from Sri Lanka. Adjustment for socioeconomic position slightly attenuated the risks. Adjusting for BMI resulted in increased ORs for women, especially from Asian countries. The separate and joint effects of migration and overweight on GDM risk differed substantially between the countries of origin (P value interaction term < .001). Immigrants with 10 or more years of residency had a 56% increased risk of GDM (OR 1.56, 95% CI 1.44-1.68) compared to immigrants with less than 5 years in Denmark. This risk was somewhat diluted when adjusting for age and BMI. CONCLUSIONS This study demonstrates substantial variation in the risk of GDM according to country of origin. The risk associations are only slightly affected by socioeconomic position and BMI.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Steno Diabetes Center, Gentofte, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Wan CS, Abell S, Aroni R, Nankervis A, Boyle J, Teede H. Ethnic differences in prevalence, risk factors, and perinatal outcomes of gestational diabetes mellitus: A comparison between immigrant ethnic Chinese women and Australian-born Caucasian women in Australia. J Diabetes 2019; 11:809-817. [PMID: 30773821 DOI: 10.1111/1753-0407.12909] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/03/2019] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. Ethnic differences in risk factors and perinatal outcomes are clinically important. Chinese women constitute approximately 10% of the world's population, and are an increasing migrant population, yet prevalence, risk factors, and outcomes of GDM in this population are insufficiently explored. METHODS A retrospective study of a large pregnancy dataset comparing GDM prevalence, risk factors, and perinatal outcomes between immigrant ethnic Chinese women and Australian-born Caucasian women was conducted using logistic regression. RESULTS Overall, 73 517 births were extracted from the pregnancy databases of two of Australia's largest maternity services. Chinese women (n = 3419) had a 4-fold higher risk of GDM than Caucasians (n = 28 594) after adjusting for risk factors of GDM. A past history of GDM (adjusted odds ratio [aOR] 5.24; 95% confidence interval [95% CI] 2.91-9.42] was the main GDM risk factor in both groups. Other GDM risk factors varied between groups. Perinatal outcomes in Chinese women with and without GDM were similar, except for neonatal hypoglycemia (aOR 2.01; 95% CI 1.14-3.56]. Caucasian women with GDM had more adverse perinatal outcomes than women without GDM. After adjusting for confounders, Chinese women with GDM had a lower risk of labor induction, large-for-gestational-age babies, neonatal hypoglycemia, respiratory distress, and low Apgar scores than Caucasian women with GDM. CONCLUSIONS Differences in prevalence, risk profile, and adverse outcomes in GDM were evident between ethnic Chinese and Caucasian women. A precision medicine approach to GDM may be warranted considering ethnicity and individual risk profiles rather than a one-size-fits-all approach.
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Affiliation(s)
- Ching S Wan
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sally Abell
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Rosalie Aroni
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alison Nankervis
- Departments of Diabetes and Endocrinology, The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynecology, Monash Health, Clayton, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
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Vandyousefi S, Goran MI, Gunderson EP, Khazaee E, Landry MJ, Ghaddar R, Asigbee FM, Davis JN. Association of breastfeeding and gestational diabetes mellitus with the prevalence of prediabetes and the metabolic syndrome in offspring of Hispanic mothers. Pediatr Obes 2019; 14:e12515. [PMID: 30734524 PMCID: PMC7470230 DOI: 10.1111/ijpo.12515] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effects of breastfeeding (BF) on metabolic syndrome (MetS) and diabetes mellitus in children exposed to gestational diabetes mellitus (GDM) in utero have rarely been evaluated. OBJECTIVE This study assessed BF and GDM in relation to the prevalence of prediabetes and MetS in Hispanic children and adolescents (8-19 y). METHODS This is a longitudinal study with 229 Hispanic children (8-13 y) with overweight/obesity, family history of diabetes, and an average of four annual visits (AV). Participants were categorized as follows: never (negative for prediabetes/MetS at all AVs), ever (positive for prediabetes/MetS at any visit), intermittent (positive for prediabetes/MetS at 1-2 AVs), and persistent (positive for prediabetes/MetS at greater than or equal to 3 AVs). RESULTS Compared with GDM offspring who were not BF (referent), GDM offspring who were BF had lower odds of persistent prediabetes (OR = 0.18; 95% CI, 0.04-0.82; P = 0.02) and MetS (OR = 0.10; 95% CI, 0.02-0.55; P = 0.008). Compared with referent group, non-GDM offspring who were BF, and non-GDM offspring not BF had lower odds of persistent prediabetes (OR = 0.10; 95% CI, 0.03-0.39; P = 0.001; OR = 0.05; 95% CI, 0.01-0.11; P < 0.001) and MetS (OR = 0.14; 95% CI, 0.04-0.59; P = 0.01 and OR = 0.04; 95% CI, 0.01-0.11; P < 0.001). CONCLUSIONS These results show BF is protective against prediabetes and MetS in offspring regardless of GDM status.
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Affiliation(s)
- Sarvenaz Vandyousefi
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Michael I. Goran
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Erfan Khazaee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Matthew J. Landry
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Reem Ghaddar
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Fiona M. Asigbee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Jaimie N. Davis
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
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Williams AD, Grantz KL, Zhang C, Nobles C, Sherman S, Mendola P. Ambient Volatile Organic Compounds and Racial/Ethnic Disparities in Gestational Diabetes Mellitus: Are Asian/Pacific Islander Women at Greater Risk? Am J Epidemiol 2019; 188:389-397. [PMID: 30452528 DOI: 10.1093/aje/kwy256] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 11/13/2018] [Indexed: 01/25/2023] Open
Abstract
US Asian/Pacific Islander (API) communities experience high air pollution levels. APIs may be predisposed to pancreatic β-cell dysfunction and have the highest prevalence of gestational diabetes mellitus (GDM) compared with other racial/ethnic groups. Exposure to high levels of volatile organic compounds (VOCs) impairs pancreatic β-cell function, leading to insulin resistance, but racial/ethnic differences in this association are unexamined. We analyzed singleton deliveries (n = 220,065) from the Consortium on Safe Labor (2002-2008). Exposure to 14 VOCs in each hospital referral region was based on modified Community Multiscale Air Quality models. Logistic regression estimated odds ratios for GDM associated with high (≥75th percentile) versus low (<75th percentile) VOC exposure 3 months before conception and during the first trimester of pregnancy. Preconception and first-trimester exposure to high VOC levels was associated with increased odds of GDM among whites and APIs. GDM risk was significantly higher for APIs than whites for most VOCs. Preconception benzene exposure was associated with 29% (95% confidence interval: 12, 47) increased odds of GDM among whites compared with 45% (95% confidence interval: 16, 81) increased odds among APIs. These findings highlight environmental health disparities affecting pregnant women. Increased focus on GDM risk in US API communities is warranted.
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Affiliation(s)
- Andrew D Williams
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Carrie Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Sim YE, Sia AL, Tan CW, Sng BL. Implications of diabetes in obstetric anaesthesia. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Farahvar S, Walfisch A, Sheiner E. Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review. Expert Rev Endocrinol Metab 2019; 14:63-74. [PMID: 30063409 DOI: 10.1080/17446651.2018.1476135] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/09/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Established risk factors for gestational diabetes mellitus (GDM) include ethnicity, obesity, and family history of diabetes. Untreated GDM patients have higher rates of maternal and perinatal morbidity. GDM is an independent risk factor for future longer-term risk of type 2 diabetes mellitus (T2DM), metabolic syndrome, cardiovascular morbidity, malignancies, ophthalmic, psychiatric, and renal disease in the mother. Offspring risk long-term adverse health outcomes, including T2DM, subsequent obesity, impacted neurodevelopmental outcome, increased neuropsychiatric morbidity, and ophthalmic disease. AREAS COVERED We critically review data from retrospective, prospective, and meta-analysis studies pertaining to established GDM risk factors, complications during pregnancy and birth (both mother and offspring), and long-term consequences (both mother and offspring). EXPERT COMMENTARY Many of the adverse consequences of GDM might be avoided with proper management and treatment. Patients belonging to high-risk ethnic groups, and/or with body mass index ≥ 25 kg/m2, and/or known history of diabetes in first-degree relatives may benefit from universal screening and diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Group (IADPSG). The IADPSG one-step method has several advantages, including simplicity of execution, greater patient-friendliness, and higher diagnostic accuracy. Additionally, evidence suggests that the recent increased popularity of bariatric surgery will help to decrease GDM rates over next 5 years. Similarly, metformin may be useful for treating and preventing obstetrical complications in confirmed GDM patients.
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Affiliation(s)
- Salar Farahvar
- a Department of Obstetrics and Gynecology, Faculty of Health, Sciences, Soroka University Medical Center, Ben-Gurion , University of the Negev , Beer Sheva , Israel
| | - Asnat Walfisch
- a Department of Obstetrics and Gynecology, Faculty of Health, Sciences, Soroka University Medical Center, Ben-Gurion , University of the Negev , Beer Sheva , Israel
| | - Eyal Sheiner
- a Department of Obstetrics and Gynecology, Faculty of Health, Sciences, Soroka University Medical Center, Ben-Gurion , University of the Negev , Beer Sheva , Israel
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Larrabure-Torrealva GT, Martinez S, Luque-Fernandez MA, Sanchez SE, Mascaro PA, Ingar H, Castillo W, Zumaeta R, Grande M, Motta V, Pacora P, Gelaye B, Williams MA. Prevalence and risk factors of gestational diabetes mellitus: findings from a universal screening feasibility program in Lima, Peru. BMC Pregnancy Childbirth 2018; 18:303. [PMID: 30021539 PMCID: PMC6052534 DOI: 10.1186/s12884-018-1904-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is a global public health concern with potential implications for the health of a mother and her offspring. However, data on the prevalence and risk factors of GDM in Latin America are scarce. The study was designed to estimate the prevalence of GDM and identify maternal risk factors among Peruvian women. Methods A cross-sectional study was conducted among 1300 pregnant women attending a prenatal clinic in Lima, Peru. GDM was diagnosed using an Oral Glucose Tolerance Test (OGTT) performed between 24 and 28 gestational weeks using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Depression status was assessed using the Patient Health Questionnaire-9. Multivariate logistic regression models were used to identify risk factors of GDM. Results Approximately 16% of pregnant women were diagnosed with GDM. The prevalence of obesity and depression were 24.4 and 10.6%, respectively. After adjusting for confounders, mid-pregnancy obesity was associated with a 1.64-fold increased odds of GDM (OR: 1.64; 95% CI: 1.03–2.61). Participants with a family history of diabetes had a 1.5-fold increased odds of developing GDM (OR: 1.51, 95% CI: 1.10–2.07) as compared to women without this family history. Depression was associated with a 1.54-fold increased odds of GDM (OR: 1.54; 95% CI:1.09–2.17). Conclusions GDM is highly prevalent and was associated with maternal obesity, family history of diabetes and antepartum depression among Peruvian women. Intervention programs aimed at early diagnoses and management of GDM need to take maternal obesity, family history of diabetes and antepartum depression into account. Electronic supplementary material The online version of this article (10.1186/s12884-018-1904-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gloria T Larrabure-Torrealva
- Instituto Nacional Materno Perinatal de Lima, Lima, Perú.,Departamentos de Medicina y Ginecología y Obstetricia, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Stephanie Martinez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 505F, Boston, MA, 02115, USA
| | - Miguel Angel Luque-Fernandez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 505F, Boston, MA, 02115, USA
| | - Sixto E Sanchez
- Asociación Civil Proyectos en Salud, A.C. PROESA, Lima, Perú.,Facultad de Medicina, Universidad Particular San Martin de Porres, Lima, Peru
| | - Pedro A Mascaro
- Instituto Nacional Materno Perinatal de Lima, Lima, Perú.,Departamentos de Medicina y Ginecología y Obstetricia, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Hugo Ingar
- Instituto Nacional Materno Perinatal de Lima, Lima, Perú
| | | | - Rina Zumaeta
- Instituto Nacional Materno Perinatal de Lima, Lima, Perú
| | - Mirtha Grande
- Asociación Civil Proyectos en Salud, A.C. PROESA, Lima, Perú
| | - Vicky Motta
- Asociación Civil Proyectos en Salud, A.C. PROESA, Lima, Perú
| | - Percy Pacora
- Departamentos de Medicina y Ginecología y Obstetricia, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 505F, Boston, MA, 02115, USA.
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 505F, Boston, MA, 02115, USA
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Casagrande SS, Linder B, Cowie CC. Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women. Diabetes Res Clin Pract 2018; 141:200-208. [PMID: 29772286 DOI: 10.1016/j.diabres.2018.05.010] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/13/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
AIMS The true prevalence of gestational diabetes (GDM) in the United States is unknown. This study determined the prevalence of GDM and a subsequent diagnosis of diabetes in a nationally representative sample of U.S. women. METHODS The crude and age-adjusted prevalence of GDM and subsequent diabetes were evaluated by sociodemographic and health-related characteristics among women age ≥20 years in the National Health and Nutrition Examination Surveys, 2007-2014 (N = 8185). Logistic regression analyzed independent factors associated with GDM and subsequent diabetes. RESULTS The prevalence of GDM was 7.6%. Women who were Mexican American (vs. non-Hispanic white), had ≥4 live births (vs. 1), had a family history of diabetes, or were obese (vs. normal weight) had a higher age-standardized prevalence of GDM (each p < 0.04). Among women with a history of GDM, 19.7% had a subsequent diagnosis of diabetes; subsequent diabetes diagnosis was higher for those with health insurance, more time since GDM diagnosis, greater parity, family history of diabetes, and obesity, and lower for those with higher education and income (all p ≤ 0.005). By logistic regression, significant factors associated with GDM were age at first birth, parity, family history of diabetes, and obesity; significant factors for subsequent diabetes were older age, greater years since GDM diagnosis, less education, family history of diabetes, and obesity (each p < 0.01). CONCLUSIONS The prevalence of GDM in the U.S. was 7.6%, with 19.7% of these women having a subsequent diabetes diagnosis. Women with a history of GDM, family history of diabetes, and obesity should be carefully monitored for dysglycemia.
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Affiliation(s)
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Blvd, Bethesda, MD 20892, USA
| | - Catherine C Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Blvd, Bethesda, MD 20892, USA
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Walter E, Tsumi E, Wainstock T, Spiegel E, Sheiner E. Maternal gestational diabetes mellitus: is it associated with long-term pediatric ophthalmic morbidity of the offspring? J Matern Fetal Neonatal Med 2018; 32:2529-2538. [PMID: 29429374 DOI: 10.1080/14767058.2018.1439918] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine whether children born to mothers with gestational diabetes mellitus (GDM) are at increased risk to develop of pediatric ophthalmic morbidity. MATERIALS AND METHODS In this population based cohort study, all deliveries between 1991 and 2014 were included. Congenital malformations, multiple gestations, and patients lacking prenatal care were excluded from analysis. Mothers were defined as either having no GDM, having diet-treated GDM, or medically treated GDM. Outcomes were defined as different ophthalmic morbidities of the offspring until the age of 18. Kaplan-Meier curves were used to compare the cumulative morbidity in each group, and a Cox proportional hazard model was used to control for possible confounders. RESULTS During the study period, 238,622 deliveries met the inclusion criteria, of those 4.0% (n = 9601) of mothers were diagnosed with GDM treated by diet, and an additional 1.0% (n = 2398) were diagnosed with GDM treated by medication. Offsprings of patients with GDM treated by medication had a higher cumulative incidence of ophthalmic morbidity when compared to the other groups (Kaplan-Meier log rank test p = .038). GDM treated by medication was found to be an independent risk factor for long-term ophthalmic morbidity, in a cox multivariable model (adjusted HR: 1.5, 95%CI: 1.05-2.1, p = .025). CONCLUSIONS Gestational diabetes mellitus treated by medication is associated with an increased risk for long-term pediatric ophthalmic morbidity.
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Affiliation(s)
- Eyal Walter
- a Department of Ophthalmology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel
| | - Erez Tsumi
- a Department of Ophthalmology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel
| | - Tamar Wainstock
- b Public Health , Ben-Gurion University of the Negev , Be'er Sheva , Israel
| | - Efrat Spiegel
- c Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel
| | - Eyal Sheiner
- c Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel
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Xu X, Liu Y, Liu D, Li X, Rao Y, Sharma M, Zhao Y. Prevalence and Determinants of Gestational Diabetes Mellitus: A Cross-Sectional Study in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121532. [PMID: 29292753 PMCID: PMC5750950 DOI: 10.3390/ijerph14121532] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/25/2017] [Accepted: 11/30/2017] [Indexed: 01/27/2023]
Abstract
UNLABELLED Objectives: This study aimed to identify the prevalence of gestational diabetes mellitus (GDM) and to examine its associations with social and behavioral factors, maternal body mass index (BMI), anemia, and hypertension. Methods: A cross-sectional analysis was performed on data collected from 2345 pregnant women from 16 hospitals in five selected provinces in mainland China. RESULTS Prevalence of GDM was as follows: overall: 3.7%; pregnant women in the first pregnancy: 3.4%; pregnant women in the second pregnancy: 4.6%. Compared with early pregnancy women, late-stage pregnant women were more likely to have GDM (OR = 4.32, 95% CI (1.82, 10.27)). Compared with 18-25 years old pregnant women, women aged 36-45 years were more likely to have GDM (OR = 3.98, 95% CI (1.41, 11.28). Compared with non-hypertensive patients, hypertensive patients were more likely to have GDM (OR = 6.93, 95% CI (1.28, 37.64)). However, second pregnancy, high maternal BMI, prolonged screen time (TV-viewing time, computer-using time, and mobile-phone using time), insufficient and excessive sleep duration, poor sleep quality, smoking, and secondhand smoke exposure were not significantly associated with an increased risk of GDM. Conclusions: Women in the second pregnancy do not appear to predict an increased risk for developing GDM than women in the first pregnancy. High-risk groups of GDM included women in their late pregnancy, aged 36-45 years old, and with hypertension. The findings will contribute to an improved understanding of social and behavioral determinants of GDM in Chinese population and contribute to the development of health-prevention promotion interventions to address GDM.
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Affiliation(s)
- Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Ying Liu
- School of the Second Clinical, Chongqing Medical University, Chongqing 400016, China; lyniniy @163.com
| | - Dengyuan Liu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Xiaoming Li
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Yunshuang Rao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS 39213, USA.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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Lin PC, Hung CH, Chan TF, Lin KC, Hsu YY, Ya-Ling Tzeng. The risk factors for gestational diabetes mellitus: A retrospective study. Midwifery 2016; 42:16-20. [PMID: 27705836 DOI: 10.1016/j.midw.2016.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/15/2016] [Accepted: 09/21/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the risk factors for developing GDM among Taiwanese pregnant women. DESIGN A retrospective cohort and case-control study. SETTING At a medical centre in Southern Taiwan. PARTICIPANTS The hospitalised pregnant women who were diagnosed with either GDM or normal glucose tolerance (NGT) between 1997 and 2011. The glucose tolerance test results were interpreted according to criteria established by the National Diabetes Data Group for GDM. Participants were divided into either a GDM group (case group) or a normal glucose tolerance (NGT) group (control group) in order to determine the risk factors for GDM. MEASUREMENTS With a retrospective chart review, data regarding demographics, a family history of diabetes, history of gestation, and physiological index for pre- and postpregnancy periods were collected. χ2 tests and independent t tests were used to examine the correlations between demographic characteristics and GDM. Stepwise multivariate logistic regression was used to determine the factors associated with GDM. FINDINGS The results of the comparison between the GDM group (n=106) and the NGT group (n=406) showed that the risk factors for GDM were maternal age, education, a family history of diabetes, and prepregnancy body mass index (BMI). KEY CONCLUSION AND IMPLICATION FOR PRACTICE Older age, lower levels of education, a family history of diabetes, and higher prepregnancy BMI were significant risk factors for GDM. In addition to performing risk factor assessment, health care providers should proactively promote the importance of GDM screening to pregnant women at their first antenatal visit.
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Affiliation(s)
- Pei-Chao Lin
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan.
| | - Chich-Hsiu Hung
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan.
| | - Te-Fu Chan
- Department of Obstetrics and Gynecology, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, No. 100, Tz-You 1st Rd., Kaohsiung City 80756, Taiwan.
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, Community Medicine Research Center, National Yang-Ming University, No. 155, Linong Street Sec. 2, Taipei City 11221, Taiwan.
| | - Yu-Yun Hsu
- Department of Nursing, and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan City, 70101, Taiwan.
| | - Ya-Ling Tzeng
- School of Nursing and Graduate Institute of Nursing, China Medical University, No. 91, Hsueh-Shih Rd., Taichung City 40402, Taiwan.
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Alptekin H, Çizmecioğlu A, Işık H, Cengiz T, Yildiz M, Iyisoy MS. Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR. J Endocrinol Invest 2016; 39:577-83. [PMID: 26754418 DOI: 10.1007/s40618-015-0427-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the predictability of gestational diabetes mellitus (GDM) during the first trimester using the degree of insulin resistance and anthropometric measurements and to assign the risk of developing GDM by weight gained during pregnancy (WGDP). METHODS A total of 250 singleton pregnancies at 7-12 gestational weeks were studied. Body mass index (BMI), waist/hip ratio (WHR), quantitative insulin sensitivity check index (QUICKI), homeostasis model assessment-insulin resistance (HOMA-IR) scores and WGDP were determined. The backward stepwise method was applied to estimate possible associations with GDM. Cutoff points were estimated using receiver operating characteristic curve analysis. RESULTS GDM was found in 20 of 227 singleton pregnancies (8.8 %). The calculated HOMA-IR, QUICKI, BMI, WHR, WGDP, and parity were significantly associated with GDM. Logistic regression analyses showed that three covariates (HOMA-IR, BMI, WGDP) remained independently associated with GDM. It was calculated as OR 1.254 (95 % CI 1.006-1.563), AUC 0.809, sensitivity 90 %, specificity 61 % with cutoff = 2.08 for HOMA-IR; OR 1.157 (CI 1.045-1.281), AUC 0.723, sensitivity 80 %, specificity 58 % with cutoff = 25.95 for BMI; OR 1.221, (CI 1.085-1.374), AUC 0.654, sensitivity 80 %, specificity 46 % with cutoff = 4.7 for WGDP. Despite a HOMA-IR score of >3.1 in pregnant women, GDM was detected in only three of 29 patients (10.3 %) if WGDP was <4.7 kg at weeks 24-28. CONCLUSIONS First trimester screening for GDM can be achieved based on maternal anthropometric measurements and HOMA-IR. In particular, if BMI is >25.95 kg/m(2) and the HOMA-IR score >2.08, controlling weight gain may protect against GDM.
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Affiliation(s)
- Hüsnü Alptekin
- Department of Obstetrics and Gynecology, Mevlana University Faculty of Medicine, Konya, Turkey.
| | - Ahmet Çizmecioğlu
- Department of Internal Medicine, Mevlana University Faculty of Medicine, Konya, Turkey
| | - Hatice Işık
- Department of Obstetrics and Gynecology, Mevlana University Faculty of Medicine, Konya, Turkey
| | - Türkan Cengiz
- Department of Obstetrics and Gynecology, Mevlana University Faculty of Medicine, Konya, Turkey
| | - Murat Yildiz
- Department of Internal Medicine, Mevlana University Faculty of Medicine, Konya, Turkey
| | - Mehmet Sinan Iyisoy
- Department of Medical Education and Informatics, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Pu J, Zhao B, Wang EJ, Nimbal V, Osmundson S, Kunz L, Popat RA, Chung S, Palaniappan LP. Racial/Ethnic Differences in Gestational Diabetes Prevalence and Contribution of Common Risk Factors. Paediatr Perinat Epidemiol 2015; 29:436-43. [PMID: 26201385 PMCID: PMC6519933 DOI: 10.1111/ppe.12209] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The White House, the American Heart Association, the Agency for Healthcare Research and Quality, and the National Heart, Lung and Blood Institute have all recently acknowledged the need to disaggregate Asian American subgroups to better understand this heterogeneous racial group. This study aims to assess racial/ethnic differences in relative contribution of risk factors of gestational diabetes mellitus (GDM) among Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese), Hispanics, non-Hispanic blacks, and non-Hispanic whites. METHODS Pregnant women in 2007-2012 were identified through California state birth certificate records and linked to the electronic health records in a large mixed-payer ambulatory care organisation in Northern California (n = 24 195). Relative risk and population attributable fraction (PAF) for specific racial/ethnic groups were calculated to assess the contributions of advanced maternal age, overweight/obesity (Centers for Disease Control and Prevention (CDC) standards and World Health Organization (WHO)/American Diabetes Association (ADA) body mass index cut-offs for Asians), family history of type 2 diabetes, and foreign-born status. RESULTS GDM was most prevalent among Asian Indians (19.3%). Relative risks were similar across all race/ethnic groups. Advanced maternal age had higher PAFs in non-Hispanic whites (22.5%) and Hispanics (22.7%). Meanwhile family history (Asian Indians 22.6%, Chinese 22.9%) and foreign-borne status (Chinese 40.2%, Filipinos 30.2%) had higher PAFs in Asian subgroups. Overweight/obesity was the most important GDM risk factor for non-Hispanic whites, Hispanics, Asian Indians, and Filipinos when the WHO/ADA cut-off points were applied. Advanced maternal age was the only risk factor studied that was modified by race/ethnicity, with non-Hispanic white and Hispanic women being more adversely affected than other racial/ethnic groups. CONCLUSIONS Overweight/obesity, advanced maternal age, family history of type 2 diabetes, and foreign-borne status are important risk factors for GDM. The relative contributions of these risk factors differ by race/ethnicity, mainly due to differences in population prevalence of these risk factors.
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Affiliation(s)
- Jia Pu
- Research Institute, Palo Alto Medical Foundation, Palo Alto, CA
| | - Beinan Zhao
- Research Institute, Palo Alto Medical Foundation, Palo Alto, CA
| | - Elsie J. Wang
- School of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Vani Nimbal
- Research Institute, Palo Alto Medical Foundation, Palo Alto, CA
| | - Sarah Osmundson
- Lucile Packard Children’s Hospital, Stanford University School of Medicine, Stanford, CA
| | - Liza Kunz
- Research Institute, Palo Alto Medical Foundation, Palo Alto, CA
| | - Rita A. Popat
- Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, CA
| | - Sukyung Chung
- Research Institute, Palo Alto Medical Foundation, Palo Alto, CA
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Hawley NL, Brown C, Nu'usolia O, Ah-Ching J, Muasau-Howard B, McGarvey ST. Barriers to adequate prenatal care utilization in American Samoa. Matern Child Health J 2015; 18:2284-92. [PMID: 24045912 DOI: 10.1007/s10995-013-1368-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The objective of this study is to describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Using data from prenatal clinic records, women (n = 692) were categorized according to the adequacy of prenatal care utilization index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way analysis of variance and independent samples t tests. Between 2001 and 2008 85.4 % of women received inadequate prenatal care. Parity (P = 0.02), maternal unemployment (P = 0.03), and both parents being unemployed (P = 0.03) were negatively associated with the timing of prenatal care initiation. Giving birth in 2007-2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 vs. 25.12 weeks; P < 0.01) and improved adequacy of received services (95.04 vs. 83.8 %; P = 0.02). The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007-2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population.
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Affiliation(s)
- Nicola L Hawley
- The Alpert Medical School, Brown University, Providence, RI, USA,
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Yuen L, Wong VW. Gestational diabetes mellitus: Challenges for different ethnic groups. World J Diabetes 2015; 6:1024-1032. [PMID: 26240699 PMCID: PMC4515442 DOI: 10.4239/wjd.v6.i8.1024] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/09/2015] [Accepted: 05/06/2015] [Indexed: 02/05/2023] Open
Abstract
Ethnicity is defined as “belonging to a social group that has a common national or cultural tradition”. Membership of certain ethnic groups has long been associated with increased risk of gestational diabetes mellitus (GDM). Studies that examined ethnic differences amongst women with GDM were often conducted in western countries where women from various ethnic backgrounds were represented. The prevalence of GDM appears to be particularly high among women from South Asia and South East Asia, compared to Caucasian, African-American and Hispanic communities. For some, but not all ethnic groups, the body mass index is a risk factor for the development of GDM. Even within a particular ethnic group, those who were born in their native countries have a different risk profile for GDM compared to those born in western countries. In terms of treatment, medical nutrition therapy (MNT) plays a key role in the management of GDM and the prescription of MNT should be culturally sensitive. Limited studies have shown that women who live in an English-speaking country but predominantly speak a language other than English, have lower rates of dietary understanding compared with their English speaking counterparts, and this may affect compliance to therapy. Insulin therapy also plays an important role and there appears to be variation as to the progression of women who progress to requiring insulin among different ethnicities. As for peri-natal outcomes, women from Pacific Islander countries have higher rates of macrosomia, while women from Chinese backgrounds had lower adverse pregnancy outcomes. From a maternal outcome point of view, pregnant women from Asia with GDM have a higher incidence of abnormal glucose tolerance test results post-partum and hence a higher risk of future development of type 2 diabetes mellitus. On the other hand, women from Hispanic or African-American backgrounds with GDM are more likely to develop hypertension post-partum. This review highlights the fact that management needs to be individualised and the clinician should be mindful of the impact that differences in ethnicity may have on the clinical characteristics and pregnancy outcomes in women affected by GDM, particularly those living in Western countries. Understanding these differences is critical in the delivery of optimal antenatal care for women from diverse ethnic backgrounds.
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Lenoir-Wijnkoop I, van der Beek EM, Garssen J, Nuijten MJC, Uauy RD. Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia - a pilot evaluation. Front Pharmacol 2015; 6:103. [PMID: 26042038 PMCID: PMC4438224 DOI: 10.3389/fphar.2015.00103] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/25/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life. Objective: Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data. Results: The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences. Conclusion: Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the urgent need to collect more country-specific data on the incidence of macrosomic births and health outcomes. In addition, it would be of interest to further explore the long-term health economic consequences of macrosomia and related risk factors.
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Affiliation(s)
| | | | - Johan Garssen
- Department of Pharmaceutical Sciences, Utrecht University Utrecht, Netherlands ; Nutricia Research, Utrecht Netherlands
| | | | - Ricardo D Uauy
- Institute of Nutrition INTA, University of Chile Santiago, Chile
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Mac TL. Gestational DM and Diet Control. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lynch CP, Baker N, Korte JE, Mauldin JG, Mayorga ME, Hunt KJ. Increasing prevalence of diabetes during pregnancy in South Carolina. J Womens Health (Larchmt) 2015; 24:316-23. [PMID: 25786128 DOI: 10.1089/jwh.2014.4968] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The objective of our study was to examine the prevalence of diabetes during pregnancy at the population level in SC from January 1996 through December 2008. METHODS The study included 387,720 non-Hispanic white (NHW), 232,278 non-Hispanic black (NHB), and 43,454 Hispanic live singleton births. Maternal inpatient hospital discharge codes from delivery (91.59%) and prenatal information (i.e., Medicaid [42.91%] and SC State Health Plan [SHP] [5.98%]) were linked to birth certificate data. Diabetes during pregnancy included gestational and preexisting, defined by prenatal and maternal inpatient International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes (i.e., 64801-64802, 64881-64882, or 25000-25092) or report on the birth certificate. RESULTS Diabetes prevalence from any source increased from 5.02% (95% confidence interval [CI]: 4.82-5.22) in 1996 to 8.37% (95% CI: 8.15-8.60) in 2008. Diabetes prevalence, standardized for maternal age and race/ethnicity from 1996 through 2008, increased from 3.38% (95% CI: 3.29-3.47) to 5.81% (95% CI: 5.71-5.91) using birth certificate data, from 3.99% (95% CI: 3.89-4.10) to 6.69% (95% CI: 6.58-6.80) using hospital discharge data, and from 4.74% (95% CI: 4.52-4.96) to 8.82% (95% CI: 8.61-9.03) using Medicaid data. Comparing birth certificate to hospital discharge, Medicaid, and SHP data, Cohen's kappa in 2008 was 0.73 (95% CI: 0.72-0.75), 0.64 (95% CI: 0.62-0.66), and 0.59 (95% CI: 0.54-0.65), respectively. CONCLUSIONS An increasing prevalence of diabetes during pregnancy is reported, as well as substantial lack of agreement in reporting of diabetes prevalence across administrative databases. Prevalence of reported diabetes during pregnancy is impacted by screening, diagnostic, and reporting practices across different data sources, as well as by actual changes in prevalence over time.
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Affiliation(s)
- Cheryl P Lynch
- 1 Department of Medicine, Medical University of South Carolina , Charleston, South Carolina
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Cosson E, Bihan H, Reach G, Vittaz L, Carbillon L, Valensi P. Psychosocial deprivation in women with gestational diabetes mellitus is associated with poor fetomaternal prognoses: an observational study. BMJ Open 2015; 5:e007120. [PMID: 25748416 PMCID: PMC4360844 DOI: 10.1136/bmjopen-2014-007120] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the prognoses associated with psychosocial deprivation in women with gestational diabetes mellitus (GDM). DESIGN Observational study considering the 1498 multiethnic women with GDM who gave birth between January 2009 and February 2012. SETTING Four largest maternity units in the northeastern suburban area of Paris. PARTICIPANTS The 994 women who completed the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. MAIN OUTCOME MEASURE Main complications of GDM (large infant for gestational age (LGA), shoulder dystocia, caesarean section, pre-eclampsia). RESULTS Psychosocial deprivation (EPICES score ≥30.17) affected 577 women (56%) and was positively associated with overweight/obesity, parity and non-European origin, and negatively associated with family history of diabetes, fruit and vegetable consumption and working status. The psychosocially deprived women were diagnosed with GDM earlier, received insulin treatment during pregnancy more often and were more likely to have LGA infants (15.1% vs 10.6%, OR=1.5 (95% CI 1.02 to 2.2), p<0.05) and shoulder dystocia (3.1% vs 1.2%, OR=2.7 (0.97 to 7.2), p<0.05). In addition to psychosocial deprivation, LGA was associated with greater parity, obesity, history of GDM, ethnicity, excessive gestational weight gain and insulin therapy. A multivariate analysis using these covariates revealed that the EPICES score was independently associated with LGA infants (per 10 units, OR=1.12 (1.03 to 1.20), p<0.01). CONCLUSIONS In our area, psychosocial deprivation is common in women with GDM and is associated with earlier GDM diagnoses and greater insulin treatment, an increased likelihood of shoulder dystocia and, independently of obesity, gestational weight gain and other confounders with LGA infants.
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Affiliation(s)
- Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
- Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France
| | - Hélène Bihan
- Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France
- Department of Diabetology, Metabolic Diseases, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, Bobigny, France
| | - Gérard Reach
- Department of Diabetology, Metabolic Diseases, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, Bobigny, France
| | - Laurence Vittaz
- Department of Endocrinology-Diabetology, Ballanger Hospital, Aulnay-Sous-Bois, France
| | - Lionel Carbillon
- Department of Obstetrics and Gynecology, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Paul Valensi
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
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Kim C, Kim SY, Sappenfield W, Wilson HG, Salihu HM, Sharma AJ. Are gestational diabetes mellitus and preconception diabetes mellitus less common in non-Hispanic black women than in non-Hispanic white women? Matern Child Health J 2015; 18:698-706. [PMID: 23793482 DOI: 10.1007/s10995-013-1295-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Based on their higher risk of type 2 diabetes, non-Hispanic blacks (NHBs) would be expected to have higher gestational diabetes mellitus (GDM) risk compared to non-Hispanic whites (NHWs). However, previous studies have reported lower GDM risk in NHBs versus NHWs. We examined whether GDM risk was lower in NHBs and NHWs, and whether this disparity differed by age group. The cohort consisted of 462,296 live singleton births linked by birth certificate and hospital discharge data from 2004 to 2007 in Florida. Using multivariable regression models, we examined GDM risk stratified by age and adjusted for body mass index (BMI) and other covariates. Overall, NHBs had a lower prevalence of GDM (2.5 vs. 3.1%, p < 0.01) and a higher proportion of preconception DM births (0.5 vs. 0.3%, p ≤ 0.01) than NHWs. Among women in their teens (risk ratio 0.56, p < 0.01) and 20-29 years of age (risk ratio 0.85, p < 0.01), GDM risk was lower in NHBs than NHWs. These patterns did not change with adjustment for BMI and other covariates. Among women 30-39 years (risk ratio 1.18, p < 0.01) and ≥40 years (risk ratio 1.22, p < 0.01), GDM risk was higher in NHBs than NHWs, but risk was higher in NHWs after adjustment for BMI. Associations between BMI and GDM risk did not vary by race/ethnicity or age group. NHBs have lower risk of GDM than NHWs at younger ages, regardless of BMI. NHBs had higher risk than NHWs at older ages, largely due to racial/ethnic disparities in overweight/obesity at older ages.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA,
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The subjective impact of a diagnosis of gestational diabetes among ethnically diverse pregnant women: a qualitative study. Can J Diabetes 2014; 39:117-22. [PMID: 25512097 DOI: 10.1016/j.jcjd.2014.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Women diagnosed with gestational diabetes mellitus (GDM) require enhanced medical care, social support and health behaviour changes to reduce the complications of pregnancy and future adverse health outcomes. Little is known about how a GDM diagnosis positively and negatively impacts women, especially those of diverse ethnic backgrounds. This qualitative study sought to gain insight into the reactions and experiences of multiethnic women diagnosed with GDM. METHODS A qualitative descriptive approach was used to analyze semistructured telephone interviews conducted with 19 pregnant women of diverse backgrounds who were diagnosed with GDM. Interviews were recorded and transcribed and then coded and analyzed using content analysis. RESULTS This study identified 2 main themes and several subthemes. First, women reported many negative effects of a GDM diagnosis, including heightened pressure to fulfill multiple roles, financial impact, and a disconnect between diabetes-prevention recommendations and their cultural practices. Second, a GDM diagnosis also had positive effects on many women. Women indicated being motivated to make health behaviour changes after a GDM diagnosis and viewed it as a wake-up call to modify their lifestyles. CONCLUSIONS To help pregnant women with self-management of gestational diabetes, healthcare providers should pay greater attention to the adverse effects of GDM on women, including role expectations, cultural issues and financial barriers. Healthcare providers also need to focus on the positive effects and capitalize on women's motivation to make lifestyle changes to reduce their future risk for diabetes.
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Ashwal E, Hadar E, Hod M. Diabetes in low-resourced countries. Best Pract Res Clin Obstet Gynaecol 2014; 29:91-101. [PMID: 25182507 DOI: 10.1016/j.bpobgyn.2014.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 11/30/2022]
Abstract
Maternal and newborn health poses one of the greatest health challenges in the developing world. Many low-income countries are now experiencing a demographic and epidemiological transition and changing of lifestyles. Thus, apparent "Western" diseases such as diabetes and obesity have been reaching the Third World countries. There is a paucity of reliable data on diabetes in pregnancy in many low-income countries. Adequate information about maternal and perinatal mortality and morbidity as a consequence of diabetes in pregnancy is scarce. This chapter presents evidence of the magnitude and impact of diabetes in pregnancy. Additionally, we discuss interventions in screening and managing diabetes in pregnancy in these specific patient populations.
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Affiliation(s)
- Eran Ashwal
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis 2014; 11:E104. [PMID: 24945238 PMCID: PMC4068111 DOI: 10.5888/pcd11.130415] [Citation(s) in RCA: 410] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The true prevalence of gestational diabetes mellitus (GDM) is unknown. The objective of this study was 1) to provide the most current GDM prevalence reported on the birth certificate and the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and 2) to compare GDM prevalence from PRAMS across 2007-2008 and 2009-2010. METHODS We examined 2010 GDM prevalence reported on birth certificate or PRAMS questionnaire and concordance between the sources. We included 16 states that adopted the 2003 revised birth certificate. We also examined trends from 2007 through 2010 and included 21 states that participated in PRAMS for all 4 years. We combined GDM prevalence across 2-year intervals and conducted t tests to examine differences. Data were weighted to represent all women delivering live births in each state. RESULTS GDM prevalence in 2010 was 4.6% as reported on the birth certificate, 8.7% as reported on the PRAMS questionnaire, and 9.2% as reported on either the birth certificate or questionnaire. The agreement between sources was 94.1% (percent positive agreement = 3.7%, percent negative agreement = 90.4%). There was no significant difference in GDM prevalence between 2007-2008 (8.1%) and 2009-2010 (8.5%, P = .15). CONCLUSION Our results indicate that GDM prevalence is as high as 9.2% and is more likely to be reported on the PRAMS questionnaire than the birth certificate. We found no statistical difference in GDM prevalence between the 2 phases. Further studies are needed to understand discrepancies in reporting GDM by data source.
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Affiliation(s)
- Carla L DeSisto
- Centers for Disease Control and Prevention, 601 Sunland Park Dr, Suite 200, El Paso, TX 79912. E-mail:
| | - Shin Y Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea J Sharma
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Cosson E, Cussac-Pillegand C, Benbara A, Pharisien I, Jaber Y, Banu I, Nguyen MT, Valensi P, Carbillon L. The diagnostic and prognostic performance of a selective screening strategy for gestational diabetes mellitus according to ethnicity in Europe. J Clin Endocrinol Metab 2014; 99:996-1005. [PMID: 24423342 DOI: 10.1210/jc.2013-3383] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT The performance of standard selective screening strategies for gestational diabetes mellitus (GDM) may vary according to ethnicity. OBJECTIVE We aimed to evaluate the diagnostic and prognostic performance of a selective screening tool to determine whether it accurately predicts GDM and events in women of different ethnicities. The tool selectively screens based on patients having one or more of the following risk factors (RFs): body mass index ≥25 kg/m(2), age ≥35 years, family history of diabetes, and personal history of GDM or macrosomia. DESIGN AND SETTING We conducted an observational prospective study at a university hospital. PARTICIPANTS We included 17 344 women of European (30.9%), North African (29.6%), Sub-Saharan African (22.2%), Caribbean (8.7%), Indian-Pakistani-Sri Lankan (5.5%), and Asian (3.3%) ethnicities who were without pregravid diabetes and had singleton deliveries (2002-2010). MAIN OUTCOME MEASURES We universally screened GDM and GDM-related events (pre-eclampsia, birth weight ≥4000 g, or dystocia). RESULTS Independent of confounding factors, North African (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.21-1.52; P < .001) and Indian-Pakistani-Sri Lankan (OR, 2.52; 95% CI, 2.13-3.00; P < .001) women had more GDM than Europeans, whereas Sub-Saharan African women had less (OR, 0.82; 95% CI, 0.71-0.94; P < .01). Having one or more RFs was associated with GDM among Europeans (OR, 1.45; 95% CI, 1.22-1.76), North African (OR, 1.33; 95% CI, 1.13-1.55), Sub-Saharan African (OR, 1.48; 95% CI, 1.20-1.83), and Caribbean (OR, 1.55; 95% CI, 1.12-2.14) women. Having one or more RFs was also associated with GDM-related events only in European (P < .01) and North African (P < .05) women, with the following incidences in Europeans: no GDM/no RF, 6.9%; no GDM/RF, 9.0%; GDM/no RF, 14.7%; and GDM/RF, 12.6%. CONCLUSION Standard selective screening criteria were not predictive of GDM in women from India-Pakistan-Sri Lanka and Asia and were associated with GDM-related events only in European and North African women. However, the women with GDM, who were routinely treated, had a poor prognosis, even for those free of RFs. These results support universal screening, irrespective of ethnicity.
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Affiliation(s)
- Emmanuel Cosson
- Paris 13 University, Sorbonne Paris Cité (E.C., C.C.-P., Y.J., I.B., M.T.N., P.V.), Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Intégré Obésité Nord Francilien, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Centre de Recherche en Nutrition Humaine Ile de France, 93143 Bondy, France; Paris 13 University, Sorbonne Paris Cité (E.C., M.T.N.), Unité Mixte de Recherche U557 INSERM/U11125 Institut National de la Recherche Agronomique/Caisse Nationale d'Assurance Maladie/Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, 93430 Bobigny, France; and Paris 13 University, Sorbonne Paris Cité (A.B., I.P., L.C.), AP-HP, Jean Verdier Hospital, Department of Obstetrics and Gynecology, 93143 Bondy, France
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Mohd Yusof BN, Firouzi S, Mohd Shariff Z, Mustafa N, Mohamed Ismail NA, Kamaruddin NA. Weighing the evidence of low glycemic index dietary intervention for the management of gestational diabetes mellitus: an Asian perspective. Int J Food Sci Nutr 2014; 65:144-50. [DOI: 10.3109/09637486.2013.845652] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Fridman M, Korst LM, Chow J, Lawton E, Mitchell C, Gregory KD. Trends in maternal morbidity before and during pregnancy in California. Am J Public Health 2013; 104 Suppl 1:S49-57. [PMID: 24354836 DOI: 10.2105/ajph.2013.301583] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined trends in maternal comorbidities in California. METHODS We conducted a retrospective cohort study of 1,551,017 California births using state-linked vital statistics and hospital discharge cohort data for 1999, 2002, and 2005. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify the following conditions, some of which were preexisting: maternal hypertension, diabetes, asthma, thyroid disorders, obesity, mental health conditions, substance abuse, and tobacco use. We estimated prevalence rates with hierarchical logistic regression models, adjusting for demographic shifts, and also examined racial/ethnic disparities. RESULTS The prevalence of these comorbidities increased over time for hospital admissions associated with childbirth, suggesting that pregnant women are getting sicker. Racial/ethnic disparities were also significant. In 2005, maternal hypertension affected more than 10% of all births to non-Hispanic Black mothers; maternal diabetes affected nearly 10% of births to Asian/Pacific Islander mothers (10% and 43% increases, respectively, since 1999). Chronic hypertension, diabetes, obesity, mental health conditions, and tobacco use among Native American women showed the largest increases. CONCLUSIONS The prevalence of maternal comorbidities before and during pregnancy has risen substantially in California and demonstrates racial/ethnic disparity independent of demographic shifts.
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Affiliation(s)
- Moshe Fridman
- Moshe Fridman is with AMF Consulting, Los Angeles, CA. Lisa M. Korst is with the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, and Childbirth Research Associates, LLC, Los Angeles. Jessica Chow is with the Departments of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles (UCLA). Kimberly D. Gregory is with the Departments of Obstetrics and Gynecology, Cedars Sinai Medical Center and David Geffen School of Medicine, UCLA. Elizabeth Lawton is with the Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, under contract with the University of California San Francisco. Connie Mitchell is with the California Department of Public Health, Maternal, Child and Adolescent Health Division, Sacramento
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Tsai PJS, Roberson E, Dye T. Gestational diabetes and macrosomia by race/ethnicity in Hawaii. BMC Res Notes 2013; 6:395. [PMID: 24083634 PMCID: PMC3849973 DOI: 10.1186/1756-0500-6-395] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/24/2013] [Indexed: 12/14/2022] Open
Abstract
Background Gestational diabetes (GDM) has been shown to have long-term sequelae for both the mother and infant. Women with GDM are at increased risk of macrosomia, which predisposes the infant to birth injuries. Previous studies noted increased rates of GDM in Asian and Pacific Islander (API) women; however, the rate of macrosomia in API women with GDM is unclear. The objective of this study was to examine the relationship between ethnicity, gestational diabetes (GDM), and macrosomia in Hawaii. Methods A retrospective cohort study was performed using Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS) data. Data from 2009–2011, linked with selected items from birth certificates, were used to examine GDM and macrosomia by ethnicity. SAS-callable SUDAAN 10.0 was used to generate odds ratios, point estimates and standard errors. Results Data from 4735 respondents were weighted to represent all pregnancies resulting in live births in Hawaii from 2009–2011. The overall prevalence of GDM in Hawaii was 10.9%. The highest prevalence of GDM was in Filipina (13.1%) and Hawaiian/Pacific Islander (12.1%) women. The lowest prevalence was in white women (7.4%). Hawaiian/Pacific Islander, Filipina, and other Asian women all had an increased risk of GDM compared to white women using bivariate analysis. Adjusting for obesity, age, maternal nativity, and smoking, Asian Pacific Islander (API) women, which includes Hawaiian/Pacific Islander, Filipina, and other Asian women, had a 50% increased odds of having GDM compared to white women when compared using multivariate analysis. Among women with GDM, the highest prevalence of macrosomia was in white women (14.5%) while the lowest was in Filipina (5.3%) women. Conclusions API women in Hawaii have increased rates of GDM compared to white women. Paradoxically, this elevated GDM risk in API women is not associated with an increased rate of macrosomia. This suggests the relationship between GDM and macrosomia is more complex in this population.
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Affiliation(s)
- Pai-Jong Stacy Tsai
- John A Burns School of Medicine, University of Hawaii, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA.
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Brown EA, Ruvolo M, Sabeti PC. Many ways to die, one way to arrive: how selection acts through pregnancy. Trends Genet 2013; 29:585-92. [DOI: 10.1016/j.tig.2013.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 02/15/2013] [Accepted: 03/08/2013] [Indexed: 01/24/2023]
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Zhang S, Cardarelli K, Shim R, Ye J, Booker KL, Rust G. Racial disparities in economic and clinical outcomes of pregnancy among Medicaid recipients. Matern Child Health J 2013; 17:1518-25. [PMID: 23065298 PMCID: PMC4039287 DOI: 10.1007/s10995-012-1162-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.
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Affiliation(s)
- Shun Zhang
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Kathryn Cardarelli
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Ruth Shim
- Department of Psychiatry, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jiali Ye
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
| | - Karla L. Booker
- Division of Maternal-Child Health, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - George Rust
- National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA 30310, USA
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Hernandez-Rivas E, Flores-Le Roux JA, Benaiges D, Sagarra E, Chillaron JJ, Paya A, Puig-de Dou J, Goday A, Lopez-Vilchez MA, Pedro-Botet J. Gestational diabetes in a multiethnic population of Spain: clinical characteristics and perinatal outcomes. Diabetes Res Clin Pract 2013; 100:215-21. [PMID: 23538268 DOI: 10.1016/j.diabres.2013.01.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/14/2012] [Accepted: 01/25/2013] [Indexed: 11/26/2022]
Abstract
AIMS To compare clinical characteristics and perinatal outcomes between immigrant and Spanish women with gestational diabetes mellitus (GDM) in a multiethnic population of Barcelona and to identify factors independently associated with the development of large-for-gestational-age (LGA) infants. METHODS Prospective study of women with GDM from five ethnic groups (Caucasian, South-Central Asian, Latin American, East Asian and Moroccan) at a single institution in Barcelona between 2004 and 2011. Maternal, gestational and newborn characteristics were recorded. RESULTS The cohort included 456 patients. In univariate analyses, Moroccan women had more frequently a pre-gestational body mass index (BMI)>25 kg/m(2) (76.4%, P=0.012), while East Asian women had lower BMI (23.41 ± 2.79 kg/m(2), P<0.001), less need for insulin therapy (14.3%, P=0.013) and the highest rate of spontaneous labor (69.8%, P=0.014) and eutocic delivery (63.8%, P=0.032). Also, Latin American women had a higher rate of Cesarean section (52.9%, P<0.001) and LGA infants (28.6%, P=0.004), and their newborns had lower umbilical cord pH (7.23 ± 0.06, P=0.005) and Apgar scores (9 [4-10], P<0.01) and a higher incidence of neonatal hypoglycemia (51.4%, P=0.045). Logistic regression analysis identified pre-gestational BMI (OR: 1.18; 95% CI: 1.09-1.27), pregnancy weight gain (OR: 1.19; 95% CI: 1.1-1.28) and insulin use during gestation (OR: 2.29; 95% CI: 1.09-4.82) as predictors of LGA infants. CONCLUSIONS Significant ethnic differences were found in clinical characteristics and perinatal outcomes of women with GDM. Latin American women had a higher frequency of adverse perinatal outcomes. Pregestational BMI, pregnancy weight gain and insulin use during pregnancy were independent predictors of LGA.
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Bjornard K, Riehle-Colarusso T, Gilboa SM, Correa A. Patterns in the prevalence of congenital heart defects, metropolitan Atlanta, 1978 to 2005. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2013; 97:87-94. [PMID: 23404870 DOI: 10.1002/bdra.23111] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 11/30/2012] [Accepted: 12/04/2012] [Indexed: 07/13/2024]
Abstract
BACKGROUND Knowledge of patterns in prevalence of congenital heart defects (CHDs) is important for clinical care, etiologic research, and prevention. We evaluated temporal and racial/ethnic trends in the birth prevalence of CHDs in metropolitan Atlanta from 1978 to 2005. METHODS Cases of CHDs were obtained from the Metropolitan Atlanta Congenital Defects Program among live born infants, stillborn infants, and pregnancy terminations of at least 20 weeks gestation. We calculated birth prevalence per 10,000 live births and used joinpoint regression analysis to calculate the average annual percent change for total CHDs and for 23 specific subtypes in the total population and among whites and blacks. To evaluate racial/ethnic variations, we calculated prevalence ratios among blacks and Hispanics compared with whites. RESULTS Between 1978 and 2005, 7301 infants and fetuses with major structural CHDs were ascertained among 1,079,062 live births (67.7 per 10,000). The prevalence of all CHDs in aggregate increased from 50.3 per 10,000 in 1978-1983 to 86.4 per 10,000 in 2000-2005. The prevalence of septal defects and vascular rings increased and the prevalence of tricuspid atresia decreased, while other CHD prevalences were stable. Racial/ethnic prevalence differences were found for all CHDs combined and muscular ventricular septal defects, aortic stenosis, and atrioventricular septal defects. CONCLUSIONS The prevalence of total CHDs, primarily common, less severe types, are increasing, with some racial/ethnic differences. Further studies could clarify the possible reasons for such variations including differences in ascertainment, risk factors, or susceptibility.
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Affiliation(s)
- Kari Bjornard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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