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

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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

• 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 Offspring at Birth

• Neonatal hypoglycemia
• Jaundice
• Respiratory distress syndrome

Cousan, Diabetes in America, 1995
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Long-term Consequencesfor 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 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, 20002208
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Healthy People 2010 Objective 5-8
(Developmental)Decrease the proportion of
pregnant women with gestational diabetes
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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

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

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Contrasting Characteristics of Hispanic/Latina
and Non-Hispanic/Latina Mothers
Characteristic Hispanic/ Latina Mothers Non-Hispanic/Latina Mothers
Age 25.3 26.4 years
Pre-pregnancy BMI 24.7 24.1 kg/m2
Number of children 1.2 1.3 children
Education years 10.5 13.5 years
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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

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Model 1 Likelihood of Obtaining Gestational
Diabetes
Gestational Diabetes
Ethnicity
plt.05 plt.01 plt.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
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Model 2 Likelihood of Obtaining Gestational
Diabetes by Ethnicity with Controls
Gestational Diabetes
Ethnicity
BMI
Education
Parity
Age
plt.05 plt.01 plt.001
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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

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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

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Model 3 Likelihood of Obtaining Gestational
Diabetes by Birth Place with Controls
Gestational Diabetes
Mothers Birth place
BMI
Education
Parity
Age
plt.05 plt.01 plt.001
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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

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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

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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 dont have a high school
  diploma

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

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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

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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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Promoting awareness among the public and among
providers
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• Contact Information
• Brenda Ralls, Research Consultant
• Utah Diabetes Prevention and Control Program
• bralls_at_utah.gov
• http//health.utah.gov/diabetes