medwireNews: Researchers report that the frequency of some adverse gestational diabetes outcomes has risen over recent years in the USA, with women from ethnic minority groups most likely to be affected.
The analysis from Kartik Venkatesh (The Ohio State University, Columbus, USA) and team, which is reported in JAMA, involved 1,560,822 women with singleton live births recorded in US National Center for Health Statistics data between 2014 and 2020, following a pregnancy in which they were diagnosed with gestational diabetes.
During this study period, the frequency of preeclampsia or gestational hypertension increased by an average of 4.2% per year, from 109.2 to 140.7 per 1000 live births, and that of maternal transfusion rose by 8.0%, from 3.5 to 5.3 per 1000 live births.
The rate of preterm birth rose by an average 0.9% per year, from 108.6 to 114.1 per 1000 live births, and that of admission to the neonatal intensive care unit (ICU) by 1.0%, from 107.2 to 114.4 per 1000 live births.
By contrast, the frequency of cesarean delivery, babies being born large for gestational age (LGA), and macrosomia fell slightly over the study period, by annual averages of 1.4%, 2.3%, and 4.7%, respectively.
“This finding may reflect utilization of more stringent criteria for the diagnosis of gestational diabetes and more intensive medical management, including changing patterns of preferred pharmacotherapy (more insulin use),” say the researchers.
“It is possible that these clinical interventions aimed at improved glycemic control may have resulted in less fetal overgrowth and fewer cesarean deliveries.”
Rates of maternal ICU admission and babies being born small for gestational age (SGA) did not significantly change over time.
Black women comprised 12% of the study cohort, and were at significantly increased risk for all adverse maternal outcomes relative to White women (48% of the cohort) and all adverse infant outcomes except for LGA and macrosomia, for which they had a significantly reduced risk. The largest difference versus White women was a 1.60-fold increased risk for having an SGA baby.
However, the researchers caution: “The current analysis focused on relatively frequent adverse outcomes, in comparison with more severe measures of maternal and neonatal morbidity and mortality, for which the relative risk is even higher for Black individuals.”
American–Indian women (1% of the cohort) also had a significantly increased risk for most adverse maternal and infant outcomes, including a 2.46-fold increased risk for transfusion when compared with White women.
Among Hispanic/Latina women (27% of the cohort), the most notable differences versus White women were significant increases in the risk for maternal and neonatal ICU admission and for preterm birth and SGA babies, with other changes being small and/or nonsignificant, or favorable.
Asian or Pacific Islander women (13% of the cohort) had an increased risk for maternal ICU admission and for having an SGA baby, relative to White women, but they also had large relative reductions in the risk for preeclampsia or gestational hypertension, and for an LGA baby and macrosomia.
Venkatesh and team say the observed ethnic differences “are likely multifactorial,” including socioeconomic factors as well as systemic racism.
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