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Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
In Reply: Although the association between
high parity and increased risk of type 2 diabetes is not well established,
it is certainly a plausible confounder because the effect of pregnancy may
mediate this relationship through increased weight gain or other independent
pathways. In our study, women were asked to report their number of pregnancies.
Additional analyses indicate that this variable was associated both with race
and diabetes risk. In general, African American women had a greater number
of pregnancies than white women (median numbers of pregnancies were 4 for
African American women and 3 for white women). In addition, greater parity
was associated with higher diabetes risk (RR, 1.12 per pregnancy; 95% confidence
interval [CI], 1.09-1.15).
However, the confounding by number of pregnancies of the association
between race and diabetes risk was minimal. After adjusting for age, family
history of diabetes, education, body mass index, waist-to-hip ratio, sports-related
and non–sports-related leisure time activity, smoking, alcohol use,
dietary energy intake, and number of pregnancies, the RR of type 2 diabetes
associated with being African American was 1.81 (95% CI, 1.50-2.17) and the
risk of type 2 diabetes associated with additional pregnancy was 1.02 (95%
CI, 0.99-1.06). In our previous analysis in which number of pregnancies was
not included in the regression model (Model 5 in Table 3 of our article),
the RR of type 2 diabetes associated with being African American was similar
at 1.85 (95% CI, 1.55-2.21).
As Drs Kahn and Williamson state, gestational diabetes is associated
with increased diabetes risk, thus the differential exclusion of gestational
diabetes with respect to race may result in higher diabetes incidence among
African American women. Unfortunately, our study did not collect specific
information on gestational diabetes.
Brancati FL, Kao WHL, Szklo M, Folsom AR, Watson RL. Race, Parity, and Gestational Diabetes as Risk Factors for Type 2 Diabetes Mellitus—Reply. JAMA. 2000;284(18):2318–2319. doi:10.1001/jama.284.18.2317
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