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Ethnic Variations in Gestational Diabetes Mellitus Among Utah Mothers and Potential Explanatory Role of Selected Risk Factors Division of Diabetes Translation May 11, 2004

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Ethnic Variations in Gestational Diabetes Mellitus Among Utah Mothers and Potential Explanatory Role of Selected Risk Factors

Division of Diabetes Translation

May 11, 2004


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Gestational Diabetes Mellitus is “. . . any degree of glucose intolerance with onset or first recognition during pregnancy.”

ADA Position Statement, Diabetes Care, 2003


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Consequences for the Mothers glucose intolerance with onset or first recognition during pregnancy.”

  • About 40% of mothers with gestational diabetes will develop diabetes within 20 years of their pregnancies

  • Some findings indicate rates as high as 70% within 28 years

Cousan, Diabetes in America,1995; Kim, et al.Diabetes Care 25, 2002


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Excess Risks of Pregnancy Complications for Mothers with Gestational Diabetes

  • Macrosomic baby

  • Breech presentation

  • Premature rupture of the membranes

  • Pre-term birth

Yang, et al., Diabetes Care 25, 2002


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Consequences for Gestational DiabetesOffspring at Birth

  • Neonatal hypoglycemia

  • Jaundice

  • Respiratory distress syndrome

Cousan, Diabetes in America, 1995


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Long-term Consequences Gestational Diabetesfor the Offspring

  • Increased risk of obesity

  • Increased risk of diabetes

Dabelea, Hanson, Lindsay, Pettitt, Imperatore, et al., Diabetes 49, 2000


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Odds for Developing Diabetes Among Siblings by Exposure to Diabetes in Utero Among Pima Population


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Diabetes Among the Diabetes in Utero Among Pima PopulationPima Indians

  • “Both genetic and environmental risk factors contribute to the high rate of diabetes in the Pimas. In Pima Indian children aged 5-19 years, the strongest single risk factor for type 2 diabetes was exposure to diabetes in utero.”

Dabelea, Hanson, Lindsay, Pettitt, Imperatore, et al., Diabetes 49, 2000:2208


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Healthy People 2010 Objective 5-8 (Developmental) Diabetes in Utero Among Pima PopulationDecrease the proportion of pregnant women with gestational diabetes


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Prevalence of Gestational Diabetes Among Utah Mothers Diabetes in Utero Among Pima Population

  • Utah was one of the first states to differentiate between pre-existing and gestational diabetes on birth certificates

  • Hispanic/Latina mothers have a higher prevalence of gestational diabetes than non-Hispanic/Latina mothers

  • There appears to be a gradual but steady increase in rates of gestational diabetes among Utah mothers



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Risk Factors for Gestational Diabetes of All Births

  • Risk factors are generally the same as for type 2 diabetes

  • Risk factors include age, body mass index (pre-pregnancy), ethnicity, and socio-economic status (education)

  • Parity



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Methods Non-Hispanic/Latina Mothers

  • We developed models to identify the factor or factors that might explain the higher prevalence of gestational diabetes in our Hispanic/Latina mothers

  • We focused on singleton births

  • We examined the effect of ethnicity, singly and adjusting for the effects of known risk factors


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Model 1: Likelihood of Obtaining Gestational Diabetes Non-Hispanic/Latina Mothers

Gestational Diabetes

Ethnicity***

p<.05; ** p<.01; ***p<.001


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Model 1 Results Non-Hispanic/Latina MothersHispanic/Latina mothers had a 70 percent higher risk of gestational diabetes than non-Hispanic/Latina mothers

Utah Office of Vital Records and Statistics, 2000-2002


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Model 2: Likelihood of Obtaining Gestational Diabetes by Ethnicity with Controls

Gestational Diabetes

Ethnicity***

BMI***

Education***

Parity

Age***

p<.05; ** p<.01; ***p<.001


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Model 2 Results Ethnicity with Controls

  • Even after adjusting for known risk factors, we still cannot explain the higher prevalence of gestational diabetes among our Hispanic/Latina mothers


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Birth Place of Utah Hispanic/Latina Mothers Ethnicity with Controls

  • One-third (33.1%) were born in U.S.

  • Over half (63.9%) were born in Mexico

  • Three percent were born elsewhere


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Model 3: Likelihood of Obtaining Gestational Diabetes by Birth Place with Controls

Gestational Diabetes

Mother’s Birth place***

BMI***

Education***

Parity

Age***

p<.05; ** p<.01; ***p<.001


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Model 3 Results Birth Place with Controls

  • Hispanic/Latina mothers born in U.S. had 50% higher prevalence of gestational diabetes than non-Hispanic/Latina mothers

  • Hispanic/Latina mothers born in Mexico had 90% higher prevalence than non-Hispanic/Latina mothers


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Model 3 Results Birth Place with Controls

  • Even after adjusting for known risk factors, we still cannot explain the higher prevalence of gestational diabetes among our Hispanic/Latina mothers born in Mexico


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What do we know about our Hispanic/Latina mothers Birth Place with Controlsborn in Mexico?

  • They have relatively high rates of gestational diabetes (4%)

  • About one of 12 were age 35 or over

  • Almost three-fourths don’t have a high school diploma



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Conclusions 1989-2002

  • Study of Utah birth records found a persistently higher risk of gestational diabetes by ethnicity even after adjusting for known risk factors

  • The risk appears to be particularly strong for Hispanic/Latina mothers born in Mexico


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Limitations 1989-2002

  • Information is only as good as what is recorded on the birth certificates

  • Information is not available on diet, exercise, family history of diabetes

  • Data are cross-sectional; i.e.,we have no way of knowing if mother had gestational diabetes in any prior pregnancy from birth records


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What can we do? 1989-2002

  • Ensure language-appropriate information on gestational diabetes is available and distributed to mothers at risk

  • Promote awareness of ways to prevent diabetes in the future among diagnosed mothers

  • Work with Utah Medicaid and WIC programs to promote awareness among our Hispanic/Latina mothers about the importance of screening for gestational diabetes



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Contact Information: 1989-2002

Brenda Ralls, Research Consultant

Utah Diabetes Prevention and Control Program

[email protected]

http://health.utah.gov/diabetes


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