Diabetes in Pregnancy Among First Nations Women in Alberta, Canada: a Retrospective Analysis

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2014 Apr 11

PMID 24716718

Citations 20

Authors

Richard T Oster

Malcolm King

Donald W Morrish

Maria J Mayan

Ellen L Toth

Affiliations

Soon will be listed here.

Abstract

Background: In addition to increasing the risk of adverse birth outcomes, diabetes in pregnancy is thought to be an important driver of the epidemic of type 2 diabetes affecting Canada's First Nations population. The relative contributions of gestational diabetes mellitus (GDM) and pre-existing diabetes are not well understood. We generated a comprehensive epidemiological profile of diabetes in pregnancy over a 10-year period among the First Nations population of Alberta, Canada.

Methods: De-identified administrative data for 427,058 delivery records were obtained for the years 2000-2009. Pregnancy risk factors and delivery outcomes were described and compared by ethnicity (First Nations vs. non-First Nations) and diabetes status. Age-adjusted prevalence values for GDM and pre-existing diabetes were calculated and were compared by ethnicity. Longitudinal changes over time were also examined. Predictors were explored using logistic regression analysis.

Results: First Nations women had more antenatal risk factors and adverse infant outcomes that were compounded by diabetes. First Nations descent was an independent predictor of diabetes in pregnancy (p < 0.001). GDM prevalence was significantly higher among First Nations (6.1%) compared to non-First Nations women (3.8%; p < 0.001), but prevalence values increased significantly over time only in non-First Nations women (4.5 average annual percent change; p < 0.05). The prevalence of pre-existing diabetes was stable over time in both groups, but First Nations women experienced a 2.5-fold higher overall prevalence compared with non-First Nations women (1.5% vs. 0.6%, respectively; p < 0.001).

Conclusions: Although First Nations women experience a higher overall prevalence of diabetes in pregnancy, the lack of increase in the prevalence over time is encouraging. However, because high-risk pregnancies and poor outcomes are more common among First Nations women, particularly those with diabetes, strategies to improve perinatal care must be implemented.

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References

Dyck R, Osgood N, Lin T, Gao A, Stang M . Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. CMAJ. 2010; 182(3):249-56. PMC: 2826466. DOI: 10.1503/cmaj.090846. View

Urquia M, Glazier R, Berger H, Ying I, De Souza L, Ray J . Gestational diabetes among immigrant women. Epidemiology. 2011; 22(6):879-80. DOI: 10.1097/EDE.0b013e31823199ee. View

Kim S, Humphrey M . Decrease in incidence of gestational diabetes mellitus in Far North Queensland between 1992 and 1996. Aust N Z J Obstet Gynaecol. 1999; 39(1):40-3. DOI: 10.1111/j.1479-828x.1999.tb03441.x. View

Hunt K, Schuller K . The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am. 2007; 34(2):173-99, vii. PMC: 2043158. DOI: 10.1016/j.ogc.2007.03.002. View

Metzger B, Gabbe S, Persson B, Buchanan T, Catalano P, Damm P . International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33(3):676-82. PMC: 2827530. DOI: 10.2337/dc09-1848. View

Moum K, Holzman G, Harwell T, Parsons S, Adams S, Oser C . Increasing rate of diabetes in pregnancy among American Indian and white mothers in Montana and North Dakota, 1989-2000. Matern Child Health J. 2004; 8(2):71-6. DOI: 10.1023/b:maci.0000025729.65328.73. View

Young T, Reading J, Elias B, ONeil J . Type 2 diabetes mellitus in Canada's first nations: status of an epidemic in progress. CMAJ. 2000; 163(5):561-6. PMC: 80466. View

Godwin M, Muirhead M, Huynh J, Helt B, Grimmer J . Prevalence of gestational diabetes mellitus among Swampy Cree women in Moose Factory, James Bay. CMAJ. 1999; 160(9):1299-302. PMC: 1230311. View

Wenman W, Joffres M, Tataryn I . A prospective cohort study of pregnancy risk factors and birth outcomes in Aboriginal women. CMAJ. 2004; 171(6):585-9. PMC: 516193. DOI: 10.1503/cmaj.1031730. View

10.

Feig D, Palda V . Type 2 diabetes in pregnancy: a growing concern. Lancet. 2002; 359(9318):1690-2. DOI: 10.1016/S0140-6736(02)08599-9. View

11.

Cheng A . Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Introduction. Can J Diabetes. 2013; 37 Suppl 1:S1-3. DOI: 10.1016/j.jcjd.2013.01.009. View

12.

Burstyn I . Antepartum risk score predicts adverse birth outcomes. J Obstet Gynaecol Can. 2010; 32(1):16-20. DOI: 10.1016/S1701-2163(16)34398-5. View

13.

Young T, Martens P, Taback S, Sellers E, Dean H, Cheang M . Type 2 diabetes mellitus in children: prenatal and early infancy risk factors among native canadians. Arch Pediatr Adolesc Med. 2002; 156(7):651-5. DOI: 10.1001/archpedi.156.7.651. View

14.

Aljohani N, Rempel B, Ludwig S, Morris M, McQuillen K, Cheang M . Gestational diabetes in Manitoba during a twenty-year period. Clin Invest Med. 2008; 31(3):E131-7. DOI: 10.25011/cim.v31i3.3470. View

15.

Kelly L, Dooley J, Cromarty H, Minty B, Morgan A, Madden S . Narcotic-exposed neonates in a First Nations population in northwestern Ontario: incidence and implications. Can Fam Physician. 2011; 57(11):e441-7. PMC: 3215628. View

16.

Damm P . Future risk of diabetes in mother and child after gestational diabetes mellitus. Int J Gynaecol Obstet. 2009; 104 Suppl 1:S25-6. DOI: 10.1016/j.ijgo.2008.11.025. View

17.

Harris S, Caulfield L, Sugamori M, Whalen E, Henning B . The epidemiology of diabetes in pregnant Native Canadians. A risk profile. Diabetes Care. 1997; 20(9):1422-5. DOI: 10.2337/diacare.20.9.1422. View

18.

Simonet F, Wilkins R, Luo Z . Temporal trends in Inuit, First Nations and non-Aboriginal birth outcomes in rural and northern Quebec. Int J Circumpolar Health. 2012; 71. PMC: 3417705. DOI: 10.3402/ijch.v71i0.18791. View

19.

Willows N, Sanou D, Bell R . Assessment of Canadian Cree infants' birth size using the WHO Child Growth Standards. Am J Hum Biol. 2010; 23(1):126-31. DOI: 10.1002/ajhb.21115. View

20.

Philipps L, Santhakumaran S, Gale C, Prior E, Logan K, Hyde M . The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis. Diabetologia. 2011; 54(8):1957-66. DOI: 10.1007/s00125-011-2180-y. View