Perinatal outcomes in Hispanic and non-Hispanic white women with mild gestational diabetes
Erica K Berggren, Lisa Mele, Mark B Landon, Catherine Y Spong, Susan M Ramin, Brian Casey, Ronald J Wapner, Michael W Varner, Dwight J Rouse, Anthony Sciscione, Patrick Catalano, Margaret Harper, George Saade, Steve N Caritis, Yoram Sorokin, Alan M Peaceman, Jorge E Tolosa, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network, J Thorp, K Dorman, S Brody, S Timlin, J Bernhardt, K Leveno, L Moseley, J Gold, D Bradford, L Fay, M Garcia, F Capellan, M Miodovnik, F Malone, S Bousleiman, H Husami, V Carmona, N Fredericks, E Gantioqui, B Greenspan, M Williams, K Anderson, P Ashby, S McAllister, S Quinn, F Castinella, A Guzman, J Steiner, J Parker, J Sheppard, J Tisdale, A Northen, W Andrews, M Carpenter, D Catlow, D Allard, M Seebeck, J Tillinghast, J Iams, F Johnson, C Latimer, E Weinandy, B Maselli, M Hoffman, E Guzman, M Talucci, T Grossman, C Perez, L Zeghibe, P Tabangin, B Mercer, B Stetzer, C Milluzzi, W Dalton, S Pichette, M Swain, P Meis, J White, L Gilstrap, K Cannon, J Martinez, D Dusek, J Moss, J Brandon, A Jackson, G Hankins, D Sharp, M Bickus, H Birkland, M Cotroneo, N Cuddy, G Norman, P Lockhart, S Blackwell, L Quast, P Simon, G Mallett, L Davis, E Lairson, C Cromett, C Naze, M Blaser, E Thom, J Zachary, B Getachew, C Cobb, L Leuchtenburg, S Gilbert, S Tolivaisa, K Howell, G D Anderson, Erica K Berggren, Lisa Mele, Mark B Landon, Catherine Y Spong, Susan M Ramin, Brian Casey, Ronald J Wapner, Michael W Varner, Dwight J Rouse, Anthony Sciscione, Patrick Catalano, Margaret Harper, George Saade, Steve N Caritis, Yoram Sorokin, Alan M Peaceman, Jorge E Tolosa, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network, J Thorp, K Dorman, S Brody, S Timlin, J Bernhardt, K Leveno, L Moseley, J Gold, D Bradford, L Fay, M Garcia, F Capellan, M Miodovnik, F Malone, S Bousleiman, H Husami, V Carmona, N Fredericks, E Gantioqui, B Greenspan, M Williams, K Anderson, P Ashby, S McAllister, S Quinn, F Castinella, A Guzman, J Steiner, J Parker, J Sheppard, J Tisdale, A Northen, W Andrews, M Carpenter, D Catlow, D Allard, M Seebeck, J Tillinghast, J Iams, F Johnson, C Latimer, E Weinandy, B Maselli, M Hoffman, E Guzman, M Talucci, T Grossman, C Perez, L Zeghibe, P Tabangin, B Mercer, B Stetzer, C Milluzzi, W Dalton, S Pichette, M Swain, P Meis, J White, L Gilstrap, K Cannon, J Martinez, D Dusek, J Moss, J Brandon, A Jackson, G Hankins, D Sharp, M Bickus, H Birkland, M Cotroneo, N Cuddy, G Norman, P Lockhart, S Blackwell, L Quast, P Simon, G Mallett, L Davis, E Lairson, C Cromett, C Naze, M Blaser, E Thom, J Zachary, B Getachew, C Cobb, L Leuchtenburg, S Gilbert, S Tolivaisa, K Howell, G D Anderson
Abstract
Objective: To compare perinatal outcomes between self-identified Hispanic and non-Hispanic white women with mild gestational diabetes mellitus (GDM) or glucose intolerance.
Methods: In a secondary analysis of a mild GDM treatment trial, we compared perinatal outcomes by race and ethnicity for 767 women with glucose intolerance (abnormal 50-g 1-hour screen, normal 100-g 3-hour oral glucose tolerance test), 371 women with mild GDM assigned to usual prenatal care, and 397 women with mild GDM assigned to treatment. Outcomes included: composite adverse perinatal outcome (neonatal death, hypoglycemia, hyperbilirubinemia, hyperinsulinemia, stillbirth, birth trauma), gestational age at delivery, birth weight, and hypertensive disorders of pregnancy. Adjusted regression models included: 100-g 3-hour oral glucose tolerance test results, parity, gestational age, body mass index, maternal age at enrollment, and current tobacco use.
Results: The sample of 1,535 women was 68.3% Hispanic and 31.7% non-Hispanic white. Among women with glucose intolerance, Hispanic women had more frequent composite outcome (37% compared with 27%, adjusted odds ratio [OR] 1.62, 95% confidence interval [CI] 1.10-2.37) with more neonatal elevated C-cord peptide (19% compared with 13%, adjusted OR 1.79, 95% CI 1.04-3.08) and neonatal hypoglycemia (21% compared with 13%, adjusted OR 2.04, 95% CI 1.18-3.53). Among women with untreated mild GDM, outcomes were similar by race and ethnicity. Among Hispanic women with treated mild GDM, composite outcome was similar to non-Hispanic white women (35% compared with 25%, adjusted OR 1.62, 95% CI 0.92-2.86), but Hispanic neonates had more frequent hyperinsulinemia (21% compared with 10%, adjusted OR 2.96, 95% CI 1.33-6.60).
Conclusion: Individual components of some neonatal outcomes were more frequent in Hispanic neonates, but most perinatal outcomes were similar between Hispanic and non-Hispanic ethnic groups.
Level of evidence: II.
Source: PubMed