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

Educational Objective
To understand risk factors for gestational diabetes.
1 Credit CME
Key Points

Question  Did gestational diabetes rates change from 2011 to 2019 among individuals at first live birth in the US, and were there differences by race and ethnicity subgroups?

Findings  In this serial, population-based, cross-sectional study of 12 610 235 individuals at first live birth aged 15 to 44 years, the age-standardized gestational diabetes rate increased from 47.6 to 63.5 per 1000 live births from 2011 to 2019. Rates increased in all racial and ethnic subgroups; in 2019, Asian Indian individuals had the highest gestational diabetes rate (129.1 per 1000 live births).

Meaning  Gestational diabetes rates among individuals with a singleton first live birth increased across all race and ethnicity subgroups in the US from 2011 to 2019.

Abstract

Importance  Gestational diabetes is associated with adverse maternal and offspring outcomes.

Objective  To determine whether rates of gestational diabetes among individuals at first live birth changed from 2011 to 2019 and how these rates differ by race and ethnicity in the US.

Design, Setting, and Participants  Serial cross-sectional analysis using National Center for Health Statistics data for 12 610 235 individuals aged 15 to 44 years with singleton first live births from 2011 to 2019 in the US.

Exposures  Gestational diabetes data stratified by the following race and ethnicity groups: 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; and non-Hispanic White.

Main Outcomes and Measures  The primary outcomes were age-standardized rates of gestational diabetes (per 1000 live births) and respective mean annual percent change and rate ratios (RRs) of gestational diabetes in non-Hispanic Asian/Pacific Islander (overall and in subgroups), non-Hispanic Black, and Hispanic/Latina (overall and in subgroups) individuals relative to non-Hispanic White individuals (referent group).

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

Conclusions and Relevance  Among individuals with a singleton first live birth in the US from 2011 to 2019, rates of gestational diabetes increased across all racial and ethnic subgroups. Differences in absolute gestational diabetes rates were observed across race and ethnicity subgroups.

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Article Information

Corresponding Author: Sadiya S. Khan, MD, MSc, Department of Preventive Medicine, 680 N Lake Shore Dr, Ste 1400, Chicago, IL 60611 (s-khan-1@northwestern.edu).

Accepted for Publication: June 22, 2021.

Author Contributions: Drs Shah and Khan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Shah, Wang, Freaney, Carnethon, McKeever Bullard, Khan.

Acquisition, analysis, or interpretation of data: Shah, Wang, Perak, Kandula, Gunderson, McKeever Bullard, Grobman, O'Brien, Khan.

Drafting of the manuscript: Shah.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Shah, Wang, Freaney, McKeever Bullard.

Obtained funding: Shah, Khan.

Administrative, technical, or material support: Shah, Freaney, O'Brien.

Supervision: Carnethon, Grobman, Khan.

Conflict of Interest Disclosures: Dr Shah reported receiving grants from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study. Mr Wang reported receiving grants from the American Heart Association (#19TPA34890060; primary investigator: Sadiya S. Khan, MD, MSc) during the conduct of the study. Dr Perak reported receiving grants from the NHLBI (K23HL145101) during the conduct of the study. Dr Gunderson reported receiving grants from National Institute of Diabetes and Digestive and Kidney Diseases as the primary investigator of several research projects funded to evaluate gestational diabetes and cardiometabolic risk in women and youth, the NHLBI as the primary investigator of research on pregnancy blood pressure patterns, the American Heart Association as a co–primary investigator in a study of epigenetic markers of gestational diabetes, and the NHLBI for research funding as the CARDIA study co-chair of the CARDIA Pregnancy-Related Exposure Working Group outside the submitted work and having a patent for Metabolite signature to predict progression to type 2 diabetes after gestational diabetes pending, for which Kaiser Foundation Research Institute has rights to the patent and she is a co-inventor. Dr O'Brien reported receiving grants from the UnitedHealth Group outside the submitted work. Dr Khan reported receiving grants from the American Heart Association (#19TPA34890060) and the NIH (P30DK092939 and P30AG059988) during the conduct of the study. No other disclosures were reported.

Funding/Support: Research reported in this publication was supported, in part, by the National Heart, Lung, and Blood Institute grant F32HL149187 (Dr Shah) and the National Institutes of Health grants KL2TR001424, P30AG059988, and P30DK092939 (Dr Khan). Research reported in this publication was also supported, in part, by the American Heart Association (#19TPA34890060; Dr Khan).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The National Vital Statistics System (NVSS) is conducted by the National Center for Health Statistics, US Centers for Disease Control and Prevention (CDC). The CDC funds the NVSS and had input into the collection and management of the birth registration data. The CDC reviewed the manuscript, provided input into secondary analyses, and approved the manuscript, according to CDC policy. The CDC had no role in the decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the NIH or the CDC.

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