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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

consequences for the mothers
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

excess risks of pregnancy complications for mothers with gestational diabetes
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

consequences for offspring at birth
Consequences for Offspring at Birth
  • Neonatal hypoglycemia
  • Jaundice
  • Respiratory distress syndrome

Cousan, Diabetes in America, 1995

long term consequences for the offspring
Long-term Consequencesfor the Offspring
  • Increased risk of obesity
  • Increased risk of diabetes

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

odds for developing diabetes among siblings by exposure to diabetes in utero among pima population
Odds for Developing Diabetes Among Siblings by Exposure to Diabetes in Utero Among Pima Population
diabetes among the pima indians
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

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Healthy People 2010 Objective 5-8 (Developmental)Decrease the proportion of pregnant women with gestational diabetes
prevalence of gestational diabetes among utah mothers
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
risk factors for gestational diabetes
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
methods
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
model 1 likelihood of obtaining gestational diabetes
Model 1: Likelihood of Obtaining Gestational Diabetes

Gestational Diabetes

Ethnicity***

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

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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

model 2 likelihood of obtaining gestational diabetes by ethnicity with controls
Model 2: Likelihood of Obtaining Gestational Diabetes by Ethnicity with Controls

Gestational Diabetes

Ethnicity***

BMI***

Education***

Parity

Age***

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

model 2 results
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
birth place of utah hispanic latina mothers
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
model 3 likelihood of obtaining gestational diabetes by birth place with controls
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

model 3 results
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
model 3 results22
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
what do we know about our hispanic latina mothers born in mexico
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
conclusions
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
limitations
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
what can we do
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
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Contact Information:

Brenda Ralls, Research Consultant

Utah Diabetes Prevention and Control Program

bralls@utah.gov

http://health.utah.gov/diabetes