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Original Investigation
August 17, 2021

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

Author Affiliations
  • 1Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 4Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 5Division of Research, Kaiser Permanente Northern California, Oakland
  • 6Centers for Disease Control and Prevention, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
  • 7Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA. 2021;326(7):660-669. doi:10.1001/jama.2021.7217
Key Points

Question  Did gestational diabetes rates change from 2011 to 2019 among individuals at first live birth in the US, and were there differences by race and ethnicity subgroups?

Findings  In this serial, population-based, cross-sectional study of 12 610 235 individuals at first live birth aged 15 to 44 years, the age-standardized gestational diabetes rate increased from 47.6 to 63.5 per 1000 live births from 2011 to 2019. Rates increased in all racial and ethnic subgroups; in 2019, Asian Indian individuals had the highest gestational diabetes rate (129.1 per 1000 live births).

Meaning  Gestational diabetes rates among individuals with a singleton first live birth increased across all race and ethnicity subgroups in the US from 2011 to 2019.

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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