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  1. Maternal Characteristics Associated with Having Gestational Diabetes Mellitus Among the 2002 Birth Cohort of California WomenAnura Ratnasiri, MSRenato Littaua DVM, MPVMMichael Curtis, PhDShabbir Ahmad, DVM, MS, PhDEpidemiology and Evaluation SectionMaternal, Child and Adolescent Health/Office of Family Planning BranchCalifornia Department of Health Services12th Annual Maternal and Child Health Epidemiology ConferenceAtlanta, Georgia

  2. Background • Gestational Diabetes Mellitus (GDM) complicates between 4% and 14% of pregnancies in the nation1. • Recurrence risk is about 30% in subsequent pregnancies2. • Women with a history of GDM have a 20-50% chance of developing type II diabetes 5-10 years after the index pregnancy, with a lifetime risk near 80%3. 1 Engelgau MM, et al. The epidemiology of diabetes and pregnancy in the U.S., 1988. Diabetes Care 18:1029–1033, 1995. 2 Nicholson, W Epidemiology and Risk Factors for Gestational Diabetes Mellitus (2006). CDC Webcast September 06, 2006. 3 Owens et al., Preconception Care and Women with or at Risk for Diabetes: Implication for Community Intervention (2006). Maternal Child Health J (2006) 10:S137-S141 Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  3. Background • GDM is treatable especially if detected early in pregnancy4 • Maternal complications associated with GDM include increased risk for pre-term labor, pregnancy-induced hypertension and caesarian section deliveries. • Fetal and neonatal complications associated with GDM include increased risk for miscarriages, stillbirths, and macrosomia. • Offspring of women with GDM are at increased risk of obesity, glucose intolerance and diabetes as children or adults. 4Langer O, , et. al. Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol 170:1036–1047, 1994 Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  4. Research Questions • What is the trend in the prevalence of GDM in California? • What are the rates of GDM across racial/ethnic and age groups among California women? • What maternal socio-demographic characteristics are associated with developing GDM? Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  5. Methods Data Sources • California hospital discharge data (HDD) files from 1997 to 2004. • 2002 HDD files were linked with the 2002 Birth Cohort File. Sample • Inclusion Criteria: • California resident women with a delivery outcome as recorded in the HDD (ICD9-CM v27.x). This includes both live births and fetal deaths. • Women with a diagnosis of GDM (ICD9-CM 648.8) as recorded in the HDD labor and delivery records. • Exclusion Criteria • Women with a diagnosis of Type I or Type II diabetes (ICD9-CM codes of 250.x, 648.0x, v58.67) as recorded in the HDD labor and delivery record. Analysis • Prevalence: (number of women with GDM / number of women with a birth) x 100 • Backward stepwise logistic regression was used to obtain adjusted odds ratios of the maternal characteristics associated with having GDM. Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  6. Percent of Resident California Women with a Diagnosis of GDM: 1997-2004 Data Source: Hospital Discharge Data, 1997-2004 Numerator: number of women with a diagnosis of GDM (ICD9-CM code 648.8) Denominator: number of hospitalized women with a birth outcome, excluding women with pre-existing diabetes (ICD9-CM Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  7. 2002 Cohort of Birthing Women in California • 2002 linked HDD and Birth Cohort Population • 509,196 resident hospitalized women with a birth • 3,730 women with pre-existing diabetes (Type I or II) were excluded. • 290 women with a diagnosis of pre-existing diabetes (Type I or II) and GDM were excluded. • 2002 linked HDD and Birth Cohort Study Sample • 505,176 resident hospitalized women with a birth and no pre-existing diabetes • 503,063 live births, 2,113 fetal deaths • 25,257 (5.0%) women were identified with a diagnosis of GDM Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  8. Percent of Women with a Diagnosis of GDMby Race/Ethnicity: 2002 Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  9. Percent of Women with a Diagnosis of GDMby Maternal Age: 2002 Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  10. Percent of Women with a Diagnosis of GDMby Education: 2002 Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  11. Percent of Women with a Diagnosis of GDM by Other Maternal Characteristics: 2002 Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  12. Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  13. Variables Included in the Multivariate Logistic Regression Model • Using bivariate analyses, all of the following variables were found to be statistically associated with a women having GDM • Age • Race/Ethnicity • Education • Delivery Payer (private v. public) • Maternal Birthplace (U.S. v. foreign born) • Plurality (singleton v. multiple birth) • Parity (two or more live births) Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  14. Bivariate Unadjusted Odds Ratios and Multivariate Logistic Regression Adjusted Odds Ratios Independent VariableUnadjusted ORAdjusted OR Age <19 (ref.) 1.0 1.0 20-24 2.2 (2.0-2.4) 2.4 (2.2-2.6) 25-29 4.5 (4.1-5.0) 5.2 (4.7-5.7) 30-34 6.8 (6.2-7.4) 8.5 (7.7-9.4) 35-39 10.1 (9.2-11.0) 13.4 (12.1-14.7) 40+ 13.5 (12.2-14.9) 18.3 (16.5-20.3) Race/Ethnicity White (ref) 1.0 1.0 American Indian 1.8 (1.5-2.2) 2.4 (2.0-2.9) Asian/Pacific Islander 2.3 (2.3-2.4) 2.1 (2.0-2.2) Hispanic 1.5 (1.5-1.6) 1.7 (1.7-1.8) African American 1.1 (1.1-1.2) 1.4 (1.3-1.5) Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  15. Bivariate Unadjusted Odds Ratios and Multivariate Logistic Regression Adjusted Odds Ratios Independent VariablesUnadjusted ORAdjusted OR Education <High School 0.89 (0.87-0.93) 1.44 (1.38-1.50) High School 1.03 (1.00-1.08) 1.52 (1.45-1.59) Some College 1.04 (1.00-1.08) 1.40 (1.34-1.46) College or more 1.00 Private Delivery Payer 1.16 (1.13-1.19) NS Foreign born 1.76 (1.72-1.81) 1.14 (1.10-1.18) Plurality (multiple birth) 1.48 (1.35-1.61) 1.34 (1.22-1.47) Parity (two or more live births) 1.44 (1.40-1.48) 1.12 (1.09-1.57) Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  16. Results of MLR Adjusted Odds Ratios with 95% CI Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  17. Results • Rate of GDM is steadily increasing in California • GDM is associated with age, race/ethnicity, education, birthplace, parity and plurality of birth • Delivery payer is not associated with having GDM • GDM risk strongly increases with age • Minority populations are at increased risk of developing GDM compared to White even after controlling for other characteristics. Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

  18. Public Health Implications • Early detection and treatment of GDM is vital to efforts to improve maternal health and birth outcomes • Importance of prenatal care • The clinical component of the California Diabetes and Pregnancy Program focus its outreach to women with increased risk for GDM for both health education and care • Improve GDM Surveillance • GDM based on secondary data is underreported • Gestational Diabetes Act of 2006 (Senate Bill 3914) • Introduced in September 2006, aims to expand research, education and treatment of GDM and obesity during pregnancy Epidemiology and Evaluation Section Maternal, Child and Adolescent Health Branch California Department of Health Services

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