Prevalence of maternal hyperglycemic subtypes by race/ethnicity and associations between these subtypes with adverse pregnancy outcomes: Findings from a large retrospective multi-ethnic cohort in the United States

Abstract

Aims: With the two-step gestational diabetes mellitus (GDM) screening approach, hyperglycemic subtypes can be identified. We aimed to investigate racial/ethnic differences in the prevalence of hyperglycemic subtypes and to examine the associations between these subtypes and adverse pregnancy outcomes.

Methods: In this retrospective cohort, 11,405 pregnancies were screened using the two-step approach. Hyperglycemic subtypes included: pregnancy-impaired glucose intolerance-I (PIGT-I), PIGT-II, GDM-I (abnormal post-load glucose only), and GDM-II (abnormal fasting & post-load glucose). Modified Poisson regressions with robust error variance were used to estimate age-adjusted prevalence ratios (PR) of hyperglycemic subtypes and multivariable-adjusted risk ratios (RR) of adverse pregnancy outcomes.

Results: The prevalence of hyperglycemic subtypes was higher in Asians (PIGT-I: 1.51 [95% confidence interval 1.35-1.69]; PIGT-II: 2.18 [1.78-2.68]; GDM-I: 2.55 [2.10-3.10]; GDM-II: 1.55 [1.08-2.21]) and Hispanics (PIGT-I: 1.32 [1.16-1.50]; PIGT-II: 2.07 [1.67-2.57]; GDM-I: 1.69 [1.35-2.13]; GDM-II: 2.68 [1.93-3.71]) than non-Hispanic Whites (NHW). Despite low GDM prevalence, Japanese and Koreans had higher PIGT prevalence than NHW. PIGT-II was positively associated with hypertensive disorders of pregnancy (1.19 [1.02-1.38]), large-for-gestational age (1.73 [1.37-2.18]), and preterm birth (PB, 1.33 [1.05-1.68]). PIGT-I (1.23 [1.04-1.45]) and GDM-I (1.56 [0.87-1.71]) were positively related to PB.

Conclusions: The prevalence of hyperglycemic subtypes varies by race/ethnicity and they have distinct health implications.

Keywords: Gestational diabetes mellitus; Hyperglycemia in pregnancy; Pregnancy; Racial differences.