Increase in gestational diabetes, NICU admissions higher in certain racial, ethnic groups

SAN DIEGO — Non-Hispanic Black women with advanced maternal age had the lowest odds of developing gestational diabetes, yet neonates of Black women with gestational diabetes at any age had the highest odds of being admitted to the NICU.

These findings were presented in two separate abstracts at the ACOG Annual Clinical & Scientific Meeting.

“Differences in outcomes appear to exist by maternal race and ethnicity,” Amy Valent, DO, an assistant professor of OB/GYN at Oregon Health and Science University and a researcher involved with both studies, told Healio. “Race is a social construct, and biological differences in outcome by race are most often due to racism. In our studies, race served as a marker for other disease-causing processes such as life stress, health care inequities, etc. Therefore, future studies will need to investigate the impact of the stressors or contributors that are disproportionately distributed by race on pregnancy outcomes.”

Gestational diabetes and advanced maternal age

In one retrospective cohort study, Deepraj Pawar, BS, a medical student at Oregon Health and Science University, Valent and colleagues analyzed singleton, non-anomalous deliveries with a gestational age of at least 20 weeks and a maternal age of at least 35 years from 2014 to 2018. They stratified patients by maternal race or ethnicity and calculated the predicted deliveries effected by gestational diabetes. In total, 3,093,536 deliveries of individuals at advanced maternal age were included in the study.

Deepraj Pawar

The probability of developing gestational diabetes increased among all women of advanced maternal age during the study period. However, gestational diabetes was most pronounced in non-Hispanic Asian and non-Hispanic Pacific Islander women, with the probability of developing this condition increasing from 19% in 2014 to 21% in 2018.

Pawar and colleagues reported that non-Hispanic American Indian or Alaskan Native women also had a higher probability of developing gestational diabetes compared with other racial and ethnic populations. Non-Hispanic Black women had the lowest rates of gestational diabetes.

Overall, the probability of gestational diabetes among women of advanced maternal age varied greatly by race and ethnicity, Pawar and colleagues wrote.

Gestational diabetes and NICU admissions

In a separate retrospective cohort study, Pawar, Valent and colleagues analyzed NICU admissions using the same dataset on women with gestational diabetes who delivered from 2014 to 2018. However, they did not exclude patients with a younger maternal age. The researchers assessed for age, parity, cigarette use, educational attainment, gestational age at delivery, birth weight and insurance type. In total, 1,104,082 deliveries were included in the study.

Pawar and colleagues reported that the predicted probability of NICU admission was insignificantly higher in 2018 than in 2014 for non-Hispanic white women, non-Hispanic Black women and Hispanic women. Also, the probability of NICU admission was insignificantly lower for non-Hispanic American Indian or Alaskan Native, non-Hispanic Asian or Native Hawaiian and Pacific Island, and non-Hispanic multiracial women in 2018 than in 2014.

Overall, the probability of NICU admission was highest, at 12.42%, among women who were non-Hispanic Black, and lowest, at 9.7%, among non-Hispanic American Indian or Alaskan Native women, according to the researchers.

“Providers may need to be more aware of unique risks patients from specific backgrounds may face to provider optimal care,” Pawar told Healio.

“We can respond to the differences in outcomes by screening, ensuring resource availability and approaching care more equitably,” she added.

References:

Hanneman N, et al. Abstract 172. Presented at: ACOG Annual Clinical & Scientific Meeting; May 6-8, 2022; San Diego.

Pawar D, et al. Abstract 146. Presented at: ACOG Annual Clinical & Scientific Meeting; May 6-8, 2022; San Diego.