Racial disparities in perinatal outcomes among women with gestational diabetes

Abstract

Background: We sought to evaluate perinatal outcomes by race/ethnicity among women with gestational diabetes mellitus (GDM).

Methods: We conducted a 14-year retrospective cohort study of women with GDM. Selected perinatal outcomes were examined. Unadjusted and adjusted prevalence ratios (PR, aPR) of perinatal outcomes, comparing Hispanic and African American women with Caucasian women, were calculated.

Results: Hispanics comprised 54% of the 1018 woman cohort. Half received medical management of GDM (52%), more than African Americans (45%) or Caucasians (39%)(p<0.05). Compared with Caucasians, Hispanics had fewer deliveries <37 weeks (aPR 0.58, 95% confidence interval [CI] 0.42-0.81), less gestational hypertension (aPR 0.43, 95% CI 0.22-0.83), larger median birth weight infants (3453 g vs 3291 g, p<0.05), and greater risk of shoulder dystocia (aPR 3.52, 95% CI 1.30-9.50). Hispanic women had fewer adverse outcomes overall compared with Caucasian or African American women.

Conclusions: We report differences between Hispanic and Caucasian women with GDM. Treatment to achieve glycemic control and reduce adverse outcomes may differ by race/ethnicity.

FIG. 1.

Flow of gestational diabetes mellitus (GDM) cohort, from eligibility through sample for analysis. NDDG, National Diabetes Data Group.

FIG. 2.

Adverse maternal and neonatal outcomes are more common among Caucasian and African American women than among Hispanic women (p<0.05): among maternal outcomes, Caucasian 50% (95% CI 44%-56%), African American 51% (95% CI 43%-59%), and Hispanic 44% (95% CI 40%-48%); among neonatal outcomes, Caucasian 51% (95% CI 45%-57%), African American 49% (95% CI 39%-55%), Hispanic 41% (95% CI 37%-45%).