Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis

BMC Pregnancy Childbirth. 2014 Apr 10:14:136. doi: 10.1186/1471-2393-14-136.


Background: In addition to increasing the risk of adverse birth outcomes, diabetes in pregnancy is thought to be an important driver of the epidemic of type 2 diabetes affecting Canada's First Nations population. The relative contributions of gestational diabetes mellitus (GDM) and pre-existing diabetes are not well understood. We generated a comprehensive epidemiological profile of diabetes in pregnancy over a 10-year period among the First Nations population of Alberta, Canada.

Methods: De-identified administrative data for 427,058 delivery records were obtained for the years 2000-2009. Pregnancy risk factors and delivery outcomes were described and compared by ethnicity (First Nations vs. non-First Nations) and diabetes status. Age-adjusted prevalence values for GDM and pre-existing diabetes were calculated and were compared by ethnicity. Longitudinal changes over time were also examined. Predictors were explored using logistic regression analysis.

Results: First Nations women had more antenatal risk factors and adverse infant outcomes that were compounded by diabetes. First Nations descent was an independent predictor of diabetes in pregnancy (p < 0.001). GDM prevalence was significantly higher among First Nations (6.1%) compared to non-First Nations women (3.8%; p < 0.001), but prevalence values increased significantly over time only in non-First Nations women (4.5 average annual percent change; p < 0.05). The prevalence of pre-existing diabetes was stable over time in both groups, but First Nations women experienced a 2.5-fold higher overall prevalence compared with non-First Nations women (1.5% vs. 0.6%, respectively; p < 0.001).

Conclusions: Although First Nations women experience a higher overall prevalence of diabetes in pregnancy, the lack of increase in the prevalence over time is encouraging. However, because high-risk pregnancies and poor outcomes are more common among First Nations women, particularly those with diabetes, strategies to improve perinatal care must be implemented.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alberta / epidemiology
  • Blood Glucose / metabolism
  • Diabetes, Gestational / blood
  • Diabetes, Gestational / diagnosis
  • Diabetes, Gestational / ethnology*
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy, High-Risk*
  • Prognosis
  • Racial Groups*
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Young Adult


  • Blood Glucose