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. 2021 Aug 17;326(7):660-669.
doi: 10.1001/jama.2021.7217.

Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019

Nilay S Shah  1   2 , Michael C Wang  1 , Priya M Freaney  1   2 , Amanda M Perak  1   3 , Mercedes R Carnethon  1 , Namratha R Kandula  1   4 , Erica P Gunderson  5 , Kai McKeever Bullard  6 , William A Grobman  1   7 , Matthew J O'Brien  1   4 , Sadiya S Khan  1   2
Affiliations

Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019

Nilay S Shah et al. JAMA. .

Abstract

Importance: Gestational diabetes is associated with adverse maternal and offspring outcomes.

Objective: To determine whether rates of gestational diabetes among individuals at first live birth changed from 2011 to 2019 and how these rates differ by race and ethnicity in the US.

Design, setting, and participants: Serial cross-sectional analysis using National Center for Health Statistics data for 12 610 235 individuals aged 15 to 44 years with singleton first live births from 2011 to 2019 in the US.

Exposures: Gestational diabetes data stratified by the following race and ethnicity groups: Hispanic/Latina (including Central and South American, Cuban, Mexican, and Puerto Rican); non-Hispanic Asian/Pacific Islander (including Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese); non-Hispanic Black; and non-Hispanic White.

Main outcomes and measures: The primary outcomes were age-standardized rates of gestational diabetes (per 1000 live births) and respective mean annual percent change and rate ratios (RRs) of gestational diabetes in non-Hispanic Asian/Pacific Islander (overall and in subgroups), non-Hispanic Black, and Hispanic/Latina (overall and in subgroups) individuals relative to non-Hispanic White individuals (referent group).

Results: Among the 12 610 235 included individuals (mean [SD] age, 26.3 [5.8] years), the overall age-standardized gestational diabetes rate significantly increased from 47.6 (95% CI, 47.1-48.0) to 63.5 (95% CI, 63.1-64.0) per 1000 live births from 2011 to 2019, a mean annual percent change of 3.7% (95% CI, 2.8%-4.6%) per year. Of the 12 610 235 participants, 21% were Hispanic/Latina (2019 gestational diabetes rate, 66.6 [95% CI, 65.6-67.7]; RR, 1.15 [95% CI, 1.13-1.18]), 8% were non-Hispanic Asian/Pacific Islander (2019 gestational diabetes rate, 102.7 [95% CI, 100.7-104.7]; RR, 1.78 [95% CI, 1.74-1.82]), 14% were non-Hispanic Black (2019 gestational diabetes rate, 55.7 [95% CI, 54.5-57.0]; RR, 0.97 [95% CI, 0.94-0.99]), and 56% were non-Hispanic White (2019 gestational diabetes rate, 57.7 [95% CI, 57.2-58.3]; referent group). Gestational diabetes rates were highest in Asian Indian participants (2019 gestational diabetes rate, 129.1 [95% CI, 100.7-104.7]; RR, 2.24 [95% CI, 2.15-2.33]). Among Hispanic/Latina participants, gestational diabetes rates were highest among Puerto Rican individuals (2019 gestational diabetes rate, 75.8 [95% CI, 71.8-79.9]; RR, 1.31 [95% CI, 1.24-1.39]). Gestational diabetes rates increased among all race and ethnicity subgroups and across all age groups.

Conclusions and relevance: Among individuals with a singleton first live birth in the US from 2011 to 2019, rates of gestational diabetes increased across all racial and ethnic subgroups. Differences in absolute gestational diabetes rates were observed across race and ethnicity subgroups.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shah reported receiving grants from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study. Mr Wang reported receiving grants from the American Heart Association (#19TPA34890060; primary investigator: Sadiya S. Khan, MD, MSc) during the conduct of the study. Dr Perak reported receiving grants from the NHLBI (K23HL145101) during the conduct of the study. Dr Gunderson reported receiving grants from National Institute of Diabetes and Digestive and Kidney Diseases as the primary investigator of several research projects funded to evaluate gestational diabetes and cardiometabolic risk in women and youth, the NHLBI as the primary investigator of research on pregnancy blood pressure patterns, the American Heart Association as a co–primary investigator in a study of epigenetic markers of gestational diabetes, and the NHLBI for research funding as the CARDIA study co-chair of the CARDIA Pregnancy-Related Exposure Working Group outside the submitted work and having a patent for Metabolite signature to predict progression to type 2 diabetes after gestational diabetes pending, for which Kaiser Foundation Research Institute has rights to the patent and she is a co-inventor. Dr O'Brien reported receiving grants from the UnitedHealth Group outside the submitted work. Dr Khan reported receiving grants from the American Heart Association (#19TPA34890060) and the NIH (P30DK092939 and P30AG059988) during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Birth Records Included for Primary Analysis in a Study of the Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US from 2011 to 2019
Records from the National Center for Health Statistics birth certificate files. Records that did not use the 2003 revised certificate of birth were not eligible for analysis because previous versions did not distinguish gestational diabetes from pregestational diabetes. Maternal characteristics for those whose records were excluded are shown in eTable 1 in the Supplement.
Figure 2.
Figure 2.. Age-Standardized Rates of Gestational Diabetes in Race and Ethnic Subgroups in Individuals Aged 15 to 44 Years With Singleton First Live Births in the US from 2011 to 2019
Corresponding data, including annual percent change in gestational diabetes rates, are shown in eTable 3 in the Supplement.
Figure 3.
Figure 3.. Rate Ratios of Age-Standardized Rates of Gestational Diabetes Among Individuals Aged 15 to 44 Years With Singleton First Live Births in Race and Ethnic Minority Subgroups Relative to Non-Hispanic White Individuals in the US in 2011 and 2019
Rate ratios in 2011 are relative to non-Hispanic White individuals in 2011 (gestational diabetes rate, 44.1 per 1000 live births). Rate ratios in 2019 are relative to non-Hispanic White individuals in 2019 (gestational diabetes rate, 57.7 per 1000 live births). Corresponding data are shown in eTable 4 in the Supplement.
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