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

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

2. Gestational Diabetes Mellitus is “. . . any degree of glucose intolerance with onset or first recognition during pregnancy.” ADA Position Statement, Diabetes Care, 2003

3. Consequences for the Mothers • 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

4. 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

5. Consequences for Offspring at Birth • Neonatal hypoglycemia • Jaundice • Respiratory distress syndrome Cousan, Diabetes in America, 1995

6. Long-term Consequencesfor the Offspring • Increased risk of obesity • Increased risk of diabetes Dabelea, Hanson, Lindsay, Pettitt, Imperatore, et al., Diabetes 49, 2000

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

8. Diabetes Among the Pima 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

9. Healthy People 2010 Objective 5-8 (Developmental)Decrease the proportion of pregnant women with gestational diabetes

10. Prevalence of Gestational Diabetes Among Utah Mothers • 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

11. Births to Mothers with Gestational Diabetes as a Percentage of All Births 1.4%

12. Risk Factors for Gestational Diabetes • 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

13. Contrasting Characteristics of Hispanic/Latina and Non-Hispanic/Latina Mothers

14. Methods • 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

15. Model 1: Likelihood of Obtaining Gestational Diabetes Gestational Diabetes Ethnicity*** p<.05; ** p<.01; ***p<.001

16. Model 1 ResultsHispanic/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

17. Model 2: Likelihood of Obtaining Gestational Diabetes by Ethnicity with Controls Gestational Diabetes Ethnicity*** BMI*** Education*** Parity Age*** p<.05; ** p<.01; ***p<.001

18. Model 2 Results • Even after adjusting for known risk factors, we still cannot explain the higher prevalence of gestational diabetes among our Hispanic/Latina mothers

19. Birth Place of Utah Hispanic/Latina Mothers • One-third (33.1%) were born in U.S. • Over half (63.9%) were born in Mexico • Three percent were born elsewhere

20. 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

21. Model 3 Results • 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

22. Model 3 Results • 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

23. What do we know about our Hispanic/Latina mothers born 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

24. Percentage of Utah Hispanic/Latina Mothers Born in Mexico 1989-2002

25. Conclusions • 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

26. Limitations • 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

27. What can we do? • 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

28. Promoting awareness among the public and among providers

32. Contact Information: Brenda Ralls, Research Consultant Utah Diabetes Prevention and Control Program bralls@utah.gov http://health.utah.gov/diabetes