‘Time to get serious’: Rate of gestational diabetes increases in US

In the United States, the rate of gestational diabetes in pregnant patients aged 15 to 44 years with a singleton first live birth increased across all racial and ethnic subgroups during a recent 8-year period, data showed.

A previous study showed that 11.1% of Asian women, 6.6% of Hispanic women, 4.8% of non-Hispanic Black women and 5.3% of non-Hispanic white women in the United States had gestational diabetes in 2016, Nilay S. Shah, MD, MPH, an assistant professor of medicine and preventive medicine at Northwestern University’s Feinberg School of Medicine, and colleagues wrote in JAMA.

“However, it is unclear whether heterogeneity in rates of gestational diabetes exist within race and ethnicity groups (including Asian Indian, Chinese, Filipina, Japanese, Korean and Vietnamese among non-Hispanic Asian populations and Cuban, Central/South American, Mexican and Puerto Rican among Hispanic/Latina populations),” Shah and colleagues wrote. “Identifying gestational diabetes patterns in these disaggregated subgroups is necessary to accurately represent these diverse populations.”

Shah and colleagues conducted a serial cross-sectional analysis of National Center for Health Statistics data on 12,610,235 women and girls in the United States aged 15 to 44 years (mean age, 26.3 years) with singleton first live births from 2011 to 2019. Among the entire cohort, 21% were Hispanic/Latina (mean age, 24.4 years), 8% were non-Hispanic Asian/Pacific Islander (mean age, 29.8 years), 14% were non-Hispanic Black (mean age, 24.3 years) and 56% were non-Hispanic white (mean age, 27 years).

“Single-race categories, which were collected on the 2003 birth certificate revision, were used to identify non-Hispanic Asian and Pacific Islander and Hispanic subgroups,” Shah and colleagues wrote. “There were no records with missing race data in this data set, but 0.8% of records were missing ethnicity information, so these individuals were included in bridged-race categories but not in subgroup analyses.”

The researchers wrote in JAMA that the overall age-standardized gestational diabetes rate significantly increased from 47.6 (95% CI, 47.1-48) per 1,000 live births in 2011 to 63.5 (95% CI, 63.1-64) per 1,000 live births in 2019, yielding a mean annual percent change of 3.7% (95% CI, 2.8-4.6). The 2019 gestational diabetes rate was 66.6 (95% CI, 65.6-67.7; RR = 1.15; 95% CI, 1.13-1.18) per 1,000 live births among the Hispanic/Latina cohort, 102.7 (95% CI, 100.7-104.7; RR = 1.78; 95% CI, 1.74-1.82) per 1,000 live births among the non-Hispanic Asian/Pacific Islander cohort, 55.7 (95% CI, 54.5-57; RR = 0.97; 95% CI, 0.94-0.99) per 1,000 live births among the non-Hispanic Black cohort and 57.7 (95% CI, 57.2-58.3) per 1,000 live births among the non-Hispanic white cohort, the reference group.

The 2019 gestational diabetes rates were highest in Asian Indian women and girls (129.1 per 1,000 live births; 95% CI, 100.7-104.7; RR = 2.24; 95% CI, 2.15-2.33). Among the Hispanic/Latina cohort, rates were highest among Puerto Rican women and girls (75.8 per 1,000 live births, 95% CI, 71.8-79.9; RR = 1.31; 95% CI, 1.24-1.39).

Shah and colleagues wrote that the increase in gestational diabetes is “likely multifactorial in etiology.” Although the risk for gestational diabetes rises with age, the mean age of women and girls giving birth “increased only modestly” during the study (2 years or fewer), according to the researchers. They also noted that the rate increases occurred simultaneously “with unfavorable increases” in the prevalence of obesity, sedentary lifestyle and poor eating habits, all of which are established risk factors for gestational diabetes.

According to the researchers, limitations to the study include the researchers’ inability “to fully evaluate the degree to which staggered state-level adoption of the 2003 birth certificate revision contributed to observed trends,” limiting the analysis to women and girls with singleton first live births and the possibility of miscoding or lack of awareness of pregestational diabetes.

Shah and colleagues’ study uncovered a “concerning trend,” Camille E. Powe, MD, an endocrinologist and co-director of the diabetes in pregnancy program at Massachusetts General Hospital, and Ebony B. Carter, MD, MPH, a physician in maternal-fetal medicine, obstetrics and gynecology at Washington University of St. Louis, wrote in a related editorial.

“The findings ... reinforce that it is time to get serious about curbing increasing rates of gestational diabetes, particularly in pregnant people from racial and ethnic minority populations,” they wrote.

References:

Powe CE, Carter EB. JAMA. 2021;doi:10.1001/jama.2021.7520.

Shah NS, et al. JAMA. 2021;doi:10.1001/jama.2021.7217.