BACKGROUND AND PURPOSE:

• Shah et al. (JAMA, 2021) determined whether rates of GDM among individuals at first live birth changed from 2011 to 2019 and how these rates differ by race and ethnicity in the US

METHODS:

• Serial cross-sectional analysis (United States)
  • Between 2011 to 2019
• Population
  • 15 to 44 years
  • Singleton first live births
• Race and ethnicity groups investigated
  • Hispanic/Latina (including Central and South American, Cuban, Mexican, and Puerto Rican)
  • Non-Hispanic Asian/Pacific Islander (including Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese)
  • Non-Hispanic Black
  • Non-Hispanic White
• Primary outcomes
  • Age-standardized rates of GDM (per 1000 live births)
  • Respective mean annual percent change and rate ratios (RRs) of GDM, relative to non-Hispanic White individuals (referent group)

RESULTS:

• 12,610,235 individuals
  • Mean (SD) age: 26.3 (5.8) years
• Race and ethnicity groups
  • Hispanic/Latina: 21%
  • Non-Hispanic Asian/Pacific Islander: 8%
  • Non-Hispanic Black: 14%
  • Non-Hispanic White: 56%
• The overall age-standardized GDM rate significantly increased from 2011 to 2019 (per 1000 live births)
  • 2011: 47.6 (95% CI, 47.1 to 48.0)
  • 2019: 63.5 (95% CI, 63.1 to 64.0)
  • Mean annual percent change of 3.7% (95% CI, 2.8% to 4.6%) per year
• 2019 GDM rates (per 1000 live births)
  • Hispanic/Latina: 66.6 (95% CI, 65.6 to 67.7)
  • Non-Hispanic Asian/Pacific Islander: 102.7 (95% CI, 100.7 to 104.7)
  • Non-Hispanic Black: 55.7 (95% CI, 54.5 to 57.0)
  • Non-Hispanic White: 57.7 (95% CI, 57.2 to 58.3)
• Compared to non-Hispanic White individuals vs referent group
  • Hispanic/Latina and non-Hispanic Asian/Pacific Islander individuals had an increased risk of GDM
    • Hispanic/Latina: RR 1.15 (95% CI, 1.13 to 1.18)
    • Non-Hispanic Asian/Pacific Islander: RR 1.78 (95% CI, 1.74 to 1.82)
  • Non-Hispanic Black individuals had a similar risk of GDM
    • Non-Hispanic Black: RR 0.97 (95% CI, 0.94 to 0.99)
• GDM rates were highest in Asian Indian participants
  • 2019 GDM rate: 129.1 (95% CI, 100.7 to 104.7)
  • RR 2.24 (95% CI 2.15 to 2.33)
• Among Hispanic/Latina participants, GDM rates were highest among Puerto Rican individuals
  • 2019 GDM rate: 75.8 (95% CI, 71.8 to 79.9)
  • RR 1.31 (95% CI, 1.24 to 1.39)
• GDM rates increased among all race and ethnicity subgroups and across all age groups

CONCLUSION:

• Rates of gestational diabetes increased between 2011 and 2019 in the US among individuals with a singleton live first birth
  • This increase was seen across all racial and ethnic subgroups
• There were differences in absolute GDM rates across race and ethnicity subgroups, with Hispanic/Latina and Non-Hispanic Asian/Pacific Islander individuals having an increased risk
  • There were differences in GDM rates within subgroups as well
• The authors note that the patterns observed in this study parallel epidemiological factors associated with diabetes type 2
• Furthermore, the authors state

Structural factors, such as access to and use of prenatal care, as well as the screening and gestational diabetes diagnostic criteria used by clinicians, have the potential to differentially influence both diagnosis and ascertainment of gestational diabetes across race and ethnicity groups

Higher cardiometabolic risk may also be related to epigenetic and lifestyle factors as well as dysregulated visceral fat deposition at lower BMI values in Asian populations, contributing to the observed burden of gestational diabetes in non-Hispanic Asian American individuals

Learn More – Primary Sources:

Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019

Related ObG Topics:

Maternal Risk Factors and Complication Trends Over the Past Three Decades

What is the Risk for Developing Type 2 Diabetes Following Gestational Diabetes?

Does Folic Acid Supplementation Before Pregnancy Reduce Risk of Gestational Diabetes?

Does Vitamin D Intake Decrease the Risk for Gestational Diabetes Mellitus?