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Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus.
Janevic, Teresa; McCarthy, Katharine; Liu, Shelley H; Huyhn, Mary; Kennedy, Joseph; Tai Chan, Hiu; Mayer, Victoria L; Vieira, Luciana; Tabaei, Bahman; Howell, Frances; Howell, Elizabeth; Van Wye, Gretchen.
Afiliação
  • Janevic T; Department of Population Health Science and Policy, the Department of Obstetrics, Gynecology, and Reproductive Science, the Division of General Internal Medicine, Department of Medicine, and the Department of Maternal and Fetal Medicine, Icahn School of Medicine at Mount Sinai, and the Department of Health & Mental Hygiene, Bureau of Vital Statistics, New York, New York; and the Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pe
Obstet Gynecol ; 142(4): 901-910, 2023 10 01.
Article em En | MEDLINE | ID: mdl-37678923
OBJECTIVE: To estimate racial and ethnic disparities in type 2 diabetes mellitus after gestational diabetes mellitus (GDM) and to investigate baseline pregnancy clinical and social or structural characteristics as mediators. METHODS: We conducted a retrospective cohort of individuals with GDM using linked 2009-2011 New York City birth and hospital data and 2009-2017 New York City A1c Registry data. We ascertained GDM and pregnancy characteristics from birth and hospital records. We classified type 2 diabetes as two hemoglobin A 1c test results of 6.5% or higher. We grouped pregnancy characteristics into clinical (body mass index [BMI], chronic hypertension, gestational hypertension, preeclampsia, preterm delivery, caesarean, breastfeeding, macrosomia, shoulder dystocia) and social or structural (education, Medicaid insurance, prenatal care, and WIC [Special Supplemental Nutrition Program for Women, Infants, and Children] participation). We used Cox proportional hazards models to estimate associations between race and ethnicity and 8-year type 2 diabetes incidence, and we tested mediation of pregnancy characteristics, additionally adjusting for age and nativity (U.S.-born vs foreign-born). RESULTS: The analytic data set included 22,338 patients with GDM. The 8-year type 2 diabetes incidence was 11.7% overall and 18.5% in Black, 16.8% in South and Southeast Asian, 14.6% in Hispanic, 5.5% in East and Central Asian, and 5.4% in White individuals with adjusted hazard ratios of 4.0 (95% CI 2.4-3.9), 2.9 (95% CI 2.4-3.3), 3.3 (95% CI 2.7-4.2), and 1.0 (95% CI 0.9-1.4) for each group compared with White individuals. Clinical and social or structural pregnancy characteristics explained 9.3% and 23.8% of Black, 31.2% and 24.7% of Hispanic, and 7.6% and 16.3% of South and Southeast Asian compared with White disparities. Associations between education, Medicaid insurance, WIC participation, and BMI and type 2 diabetes incidence were more pronounced among White than Black, Hispanic, and South and Southeast Asian individuals. CONCLUSION: Population-based racial and ethnic inequities are substantial in type 2 diabetes after GDM. Characteristics at the time of delivery partially explain disparities, creating an opportunity to intervene on life-course cardiometabolic inequities, whereas weak associations of common social or structural measures and BMI in Black, Hispanic and South and Southeast Asian individuals demonstrate the need for greater understanding of how structural racism influences postpartum cardiometabolic risk in these groups.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diabetes Gestacional / Hipertensão Induzida pela Gravidez / Diabetes Mellitus Tipo 2 Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Equity_inequality Limite: Child / Female / Humans / Infant / Newborn / Pregnancy País/Região como assunto: America do norte Idioma: En Revista: Obstet Gynecol Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diabetes Gestacional / Hipertensão Induzida pela Gravidez / Diabetes Mellitus Tipo 2 Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Equity_inequality Limite: Child / Female / Humans / Infant / Newborn / Pregnancy País/Região como assunto: America do norte Idioma: En Revista: Obstet Gynecol Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos