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Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project.
Can J Diabetes. 2020 Oct; 44(7):605-614.CJ

Abstract

OBJECTIVES

Because of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the 2 populations from 1980 to 2013.

METHODS

Using Ministry of Health administrative databases, we examined overall GDM and pre-GDM predictors among a cohort of FN and non-FN women using logistic regression models. We compared early birth complications by ethnicity and DIP status using chi-square analysis.

RESULTS

Deidentified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. Important GDM and pre-GDM predictors for FN and non-FN pregnancies were increasing maternal age, a previous high birthweight (HBW) or stillborn infant, and, most importantly, previous maternal GDM. Both GDM and pre-GDM were over 2.3-fold as likely to occur among FN in multivariable analysis. FN and non-FN pregnancies with GDM and pre-GDM had higher rates of prematurity, shoulder dystocia, caesarean section, HBW and stillborn and infant death than those with no DIP. The largest rate disparities between FN and non-FN with DIP occurred with stillborn, HBW and shoulder dystocia.

CONCLUSIONS

Along with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early mother/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in preconception, prenatal and perinatal care, are required to remove ethnicity-based disparities in DIP rates and outcomes.

Authors+Show Affiliations

Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Electronic address: roland.dyck@usask.ca.Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.Ministry of Health, Government of Saskatchewan, University of Saskatchewan, Regina, Saskatchewan, Canada.Department of Community Health and Epidemiology, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Computer Science, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32033918

Citation

Dyck, Roland F., et al. "Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project." Canadian Journal of Diabetes, vol. 44, no. 7, 2020, pp. 605-614.
Dyck RF, Karunanayake C, Pahwa P, et al. Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project. Can J Diabetes. 2020;44(7):605-614.
Dyck, R. F., Karunanayake, C., Pahwa, P., Stang, M., & Osgood, N. D. (2020). Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project. Canadian Journal of Diabetes, 44(7), 605-614. https://doi.org/10.1016/j.jcjd.2019.11.001
Dyck RF, et al. Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project. Can J Diabetes. 2020;44(7):605-614. PubMed PMID: 32033918.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project. AU - Dyck,Roland F, AU - Karunanayake,Chandima, AU - Pahwa,Punam, AU - Stang,MaryRose, AU - Osgood,Nathaniel D, Y1 - 2019/11/20/ PY - 2019/06/07/received PY - 2019/10/08/revised PY - 2019/11/05/accepted PY - 2020/2/9/pubmed PY - 2020/2/9/medline PY - 2020/2/9/entrez KW - First Nations KW - Premières Nations KW - complications KW - diabetes in pregnancy KW - diabète gestationnel KW - diabète pendant la grossesse KW - diabète prégestationnel KW - gestational diabetes KW - predictors KW - pregestational diabetes KW - prédicteurs SP - 605 EP - 614 JF - Canadian journal of diabetes JO - Can J Diabetes VL - 44 IS - 7 N2 - OBJECTIVES: Because of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the 2 populations from 1980 to 2013. METHODS: Using Ministry of Health administrative databases, we examined overall GDM and pre-GDM predictors among a cohort of FN and non-FN women using logistic regression models. We compared early birth complications by ethnicity and DIP status using chi-square analysis. RESULTS: Deidentified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. Important GDM and pre-GDM predictors for FN and non-FN pregnancies were increasing maternal age, a previous high birthweight (HBW) or stillborn infant, and, most importantly, previous maternal GDM. Both GDM and pre-GDM were over 2.3-fold as likely to occur among FN in multivariable analysis. FN and non-FN pregnancies with GDM and pre-GDM had higher rates of prematurity, shoulder dystocia, caesarean section, HBW and stillborn and infant death than those with no DIP. The largest rate disparities between FN and non-FN with DIP occurred with stillborn, HBW and shoulder dystocia. CONCLUSIONS: Along with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early mother/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in preconception, prenatal and perinatal care, are required to remove ethnicity-based disparities in DIP rates and outcomes. SN - 2352-3840 UR - https://www.unboundmedicine.com/medline/citation/32033918/Epidemiology_of_Diabetes_in_Pregnancy_Among_First_Nations_and_Non_First_Nations_Women_in_Saskatchewan_1980‒2013__Part_2:_Predictors_and_Early_Complications L2 - https://linkinghub.elsevier.com/retrieve/pii/S1499-2671(19)30713-0 DB - PRIME DP - Unbound Medicine ER -
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