 Racial/Ethnic Disparities in Gestational Diabetes Mellitus in Oregon Monica Hunsberger, MPH, RD, Ph. D 1, Rebecca J. Donatelle, Ph. D 2, Kenneth D. Rosenberg, MD, MPH 3, 4 1. (1) Oregon Health Science University, Dietetics and Nutrition Program, 3181 S. W. Sam Jackson Park Rd. , Mail code: FM 10, Portland, Oregon 97239 -3098; 2. (2) Oregon State University, Department of Public Health, Waldo Hall 254, Corvallis, OR 97331; 3. (3) Office of Family Health, Oregon Department of Human Services, 800 NE Oregon Street, Suite 850, Portland, OR 97232; (4) Oregon Health & Science University, Portland, OR 97239. INTRODUCTION Gestational diabetes mellitus is glucose intolerance that begins, or is first diagnosed, during pregnancy. The consequence of glucose intolerance is high-blood sugar. GDM complicates approximately 7% of all pregnancies, with prevalence estimates ranging from 2%-14% (American Diabetes Association, 2004). The consequences of high-blood sugar are both immediate and long-lasting for the fetus, child, and the mother. The infants of women with GDM are at increased risk for macrosomia(large-for-gestationalage), operative delivery (caesarean), shoulder dystocia, and birth trauma. Later in life the consequences of high blood sugar can be equally devastating to the child. The children of GDM pregnancies are at increased risk for overweight, obesity, metabolic syndrome and diabetes (Dörner, 2000). The American Diabetes Association recommends that offspring of women with GDM be monitored closely for the development of obesity and/or abnormalities of glucose tolerance by health professionals (ADA 2004). The mothers are also at increased risk for future blood glucose abnormalities. Women with GDM are at increased risk for hypertensive disorders, cesarean delivery, and future type 2 diabetes (ACOG, 2001). For additional information please contact: Monica Hunsberger, MPH, RD, Ph. D Dietetics and Nutrition Program Oregon Health Science University hunsberg@ohsu. edu OBJECTIVE The objective of this study was to explore risk factors for GDM among Oregon women using a population-based cross-sectional sample. RESEARCH & DESIGN METHODS Oregon PRAMS, the Pregnancy Risk Assessment Monitoring System, is an ongoing public health surveillance project of Oregon’s state health department. It combines mailed questionnaires with telephone interviews of non-respondents. Oregon PRAMS relies upon a stratified random sample of women who have recently given birth, utilizing birth certificates for the selection of the sample. Modeled after the survey developed by the Centers for Disease Control and Prevention, Oregon PRAMS began in November of 1998. The questionnaire asks a number of questions about the women’s prenatal, perinatal and postnatal experiences, attitudes and practices. Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) surveyed, from their birth certificates, a stratified random sample of postpartum women who delivered in Oregon in 2001 (n=1783; unweighted response rate 72. 1%; weighted response rate 78. 1%). Hispanic, non. Hispanic black, non Hispanic American Indian and non. Hispanic Asian/Pacific Islander women were oversampled. GDM was ascertained from birth certificates. Logistic regression was used to assess risk factors for GDM using STATA 9. 0 to account for weighted data. Logistic regression was performed with the level of significance p <. 05, using weighted data. Oregon PRAMS 2001 data was not collected under CDC protocol. RESEARCH & DESIGN METHODS CONTINUED All Oregon women who had given birth within the previous 60 -180 days were eligible for sampling. The overall response proportion was 73. 5%, weighted for stratified sampling. In 2001 there were 45, 318 births in Oregon. Analysis was conducted on the 1783 women that participated in the 2001 PRAMS survey and responded to the question regarding gestational diabetes on the birth certificate with a yes or no answer. The birth certificate provides a self-reported response to “GDM during this pregnancy” yes, no or I don’t know. RESULTS Asian women had the greatest incidence of GDM (7. 0%) followed by Hispanic women (4. 2%) and American Indians (4. 0%) in 2001. Oregon Vital statistics data indicates Asian women continue to have the highest rate of GDM, complicating 7. 88% of pregnancies, Hispanic women had the second highest rate of GDM (5. 36%), followed by American Indians (4. 87%), African Americans (3. 63%), and non-Hispanic whites (3. 38%) in 2004. RESULTS CONTINUED Seventy-seven women reported having GDM in 2001, or 4. 3% of the sample population. Being overweight or obese, as indicated by pre-pregnancy BMI, increased a women’s risk for GDM by greater than 2. 5 times (OR 2. 64, p=0. 03, CI=1. 096 -6. 365). Racial and ethic group members had a 1. 23 fold increase for GDM or 23% greater risk (OR 1. 23, p=0. 026, CI=1. 025 -1. 487). Racial and ethnic groups examined in this research included African Americans, Native American Indians, Asian/Pacific Islanders, and Hispanics. Advancing mother’s age also increases the risk for GDM (OR 1. 10, p=0. 008, CI=1. 026 -1. 182). DISCUSSION The disparities in GDM require public health intervention in order to ameliorate the upward prevalence trend. Minority groups may be at particular risk because of reduced or a lack of access to health care. In 2001 those with commercial insurance received postpartum care 80% of the time while those with Medicaid received postpartum care 55. 65 % of the time (National Committee Quality Assurance, 2004). Women with a history of GDM could benefit from intervention in the postpartum period. CONCLUSION A disproportionate number of Asian and Hispanic women have pregnancies complicated by GDM. Maternal risk factors for GDM included pre-gravid overweight, ethnic group membership and advancing age. Being overweight or obese pre-pregnancy places pregnant women at increased risk for GDM and for the long-term GDMassociated consequences to both the mother and child. Racial or ethnic group membership is also a significant risk factor for GDM which may require earlier screening and/or intervention by health professionals in the postpartum period. Advancing maternal age is a risk factor that, like ethnicity or race, may require earlier screening and monitoring by health professionals.
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