The purpose of this study was to determine racial/ethnic differences in perinatal outcomes among women with gestational diabetes mellitus.
We conducted a retrospective cohort study of 32,193 singleton births among women with gestational diabetes mellitus in California from 2006, using Vital Statistics Birth and Death Certificate and Patient Discharge Data. Data were divided by race/ethnicity: white, black, Hispanic, or Asian. Multivariable logistic regression was used to analyze associations between race/ethnicity and adverse outcomes that were controlled for potential confounders. Outcomes included primary cesarean delivery, preeclampsia, neonatal hypoglycemia, preterm delivery, macrosomia, fetal anomaly, and respiratory distress syndrome.
Compared with women in other races, black women had higher odds of preeclampsia (adjusted odds ratio [aOR], 1.57; 95% confidence interval [CI], 1.47-1.95), neonatal hypoglycemia (aOR, 1.79; 95% CI, 1.07-3.00), and preterm delivery <37 weeks' gestation (aOR, 1.56; 95% CI, 1.33-1.83). Asian women had the lowest odds of primary cesarean delivery (aOR, 0.75; 95% CI, 0.69-0.82), large-for-gestational-age infants (aOR, 0.40; 95% CI, 0.33-0.48), and neonatal respiratory distress syndrome (aOR, 0.54; 95% CI, 0.40-0.73).
Perinatal outcomes among women with gestational diabetes mellitus differ by race/ethnicity and may be attributed to inherent sociocultural differences that may impact glycemic control, the development of chronic comorbidities, genetic variability, and variation in access to prenatal care, and quantity and quality of prenatal care.
"U.S. studies of the racial/ethnic distribution of GDM have shown significant variation in its prevalence, with higher rates among Asian, Hispanic, Native American, and African American women, compared with non-Hispanic white women. Variations in the incidence of GDM, as well as perinatal outcomes, by race/ethnicity may be related to genetic factors that affect insulin resistance, diet, lifestyle, sociocultural factors, healthcare access/use, or even provider discrimination  "
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate correlations between insulin secretion and resistance in patients with gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT).
Methods: Three hundred thirty six pregnant women with an oral glucose tolerance test (OGTT) were tested and measured insulin function indices (IFI), insulin resistance indices (HOMA-IR) as well as blood serum triglycerides (TG), total cholesterol (TCH) and low density lipoprotein cholesterol (LDL-C) concentrations. GIGT patients were further divided into subgroups according to hyperglycemia appearance 1, 2 or 3 hours after glucose ingestion.
Results: GDM and GIGT correlated with age (p<0.05), family history of diabetes (p<0.05) and pre-pregnancy body mass indices (BMIs) (p<0.05). Blood pressures were higher in GDM than in GIGT and normal glucose tolerance (NGT) patients (p<0.05). The IFIs were gradually reduced (p<0.05), whereas HOMA-IR was gradually enhanced (p<0.05) in the GIGT and GDM patients. Blood serum TG, TCH and LDL-C concentrations were higher in the GIGT and GDM groups (p<0.05) and the GIGT 1 hour hyperglycemia subgroup had highest pregnancy weight gain and HOMA-IR values (p<0.05).
: Advanced age, family history of diabetes, high BMIs and blood pressure were risk factors for GIGT and GDM, which were both caused by reduced insulin secretion and enhanced insulin resistance.
[Show abstract][Hide abstract] ABSTRACT: The different screening and diagnostic methods for gestational diabetes currently in clinical use has led the NIH's Office of Disease Prevention to organize a consensus conference to better understand the potential ramifications of changing the current screening and diagnostic criteria in the United States versus keeping current practices in place. Research has demonstrated that even mild forms of hyperglycemia potentially pose significant adverse health consequences for pregnant women and their children. Thus, it is anticipated that lowering the diagnostic criteria for gestational diabetes will significantly reduce morbidity and healthcare costs in the long term. However, such a change would dramatically increase the number of women identified as having this disease and place a significantly greater burden on an already overburdened primary health care system. Although several cost-benefit analyses suggest that such a change will improve health outcomes for mothers and babies, at least one study found that these anticipated public health benefits will not occur unless a higher level of care is devoted to these newly diagnosed patients. There also is a distinct possibility that changing the diagnostic criteria for GDM will increase cesarean delivery rates, which might offset many of the public health gains engendered by diagnosing more women with this condition. The scientific dilemma to change or not to change, thus, requires a rigorous analysis of the scientific, economic, practice, and legal pros and cons to achieve a satisfactory answer.
American journal of obstetrics and gynecology 10/2012; 208(4). DOI:10.1016/j.ajog.2012.10.887 · 4.70 Impact Factor
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