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Diabetes during pregnancy and perinatal outcomes among First Nations women in Ontario, 2002/03-2014/15: a population-based cohort study.
CMAJ Open. 2020 Jan-Mar; 8(1):E214-E225.CO

Abstract

BACKGROUND

In Canada, increasing numbers of women, especially First Nations women, are affected by diabetes during pregnancy, which is a major risk factor for adverse maternal and neonatal outcomes. The aim of this study was to examine temporal trends in pregnancy outcomes and use of health care services in a population-based cohort of First Nations women compared to other women in Ontario according to diabetes status during pregnancy.

METHODS

Using health administrative databases, we created annual cohorts of pregnant women from 2002/03 to 2014/15 and identified those with preexisting diabetes and gestational diabetes. We used the Indian Register to identify First Nations women. We estimated rates of adverse maternal and infant outcomes, and measures of use of health care services in each population.

RESULTS

There were 1 671 337 deliveries among 1 065 950 women during the study period; of these deliveries, 31 417 (1.9%) were in First Nations women, and 1 639 920 (98.1%) were in other women. First Nations women had a higher prevalence of preexisting diabetes and gestational diabetes than other women in Ontario. First Nations women with preexisting diabetes had higher rates of preeclampsia (3.2%-5.6%), labour induction (33.4%-42.9%) and cesarean delivery (47.8%-53.7%) than other women in Ontario, as did First Nations women with gestational diabetes (3.2%-4.7%, 38.5%-46.9% and 41.4%-43.4%, respectively). The rate of preterm birth was similar between First Nations women and other women in Ontario. Although First Nations women had a higher rate of babies who were large for gestational age than other women, regardless of diabetes status, obstructed labour rates were similar for the 2 cohorts. Almost all First Nations women, regardless of diabetes status, were seen by a primary care provider during their pregnancy, but rates of use of specialty care were lower for First Nations women than for other women. Fifteen percent of all pregnant women with preexisting diabetes visited an ophthalmologist during their pregnancy.

INTERPRETATION

Our results confirm disparities in maternal and neonatal outcomes between First Nations women and other women in Ontario. Access to primary care for pregnant women seemed adequate, but access to specialized care, especially for women with preexisting diabetes, needs to improve.

Authors+Show Affiliations

Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont. maria.velez@queensu.ca.Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.Departments of Obstetrics and Gynaecology (Vélez) and Public Health Sciences (Vélez), Queen's University, Kingston, Ont.; ICES Central (Slater, Griffiths, Shah, Walker, Green), Toronto, Ont.; Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto; Chiefs of Ontario (Sutherland, Jones), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Health Services and Policy Research Institute (Green), Queen's University, Kingston, Ont.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32193282

Citation

Vélez, Maria P., et al. "Diabetes During Pregnancy and Perinatal Outcomes Among First Nations Women in Ontario, 2002/03-2014/15: a Population-based Cohort Study." CMAJ Open, vol. 8, no. 1, 2020, pp. E214-E225.
Vélez MP, Slater M, Griffiths R, et al. Diabetes during pregnancy and perinatal outcomes among First Nations women in Ontario, 2002/03-2014/15: a population-based cohort study. CMAJ open. 2020;8(1):E214-E225.
Vélez, M. P., Slater, M., Griffiths, R., Shah, B. R., Sutherland, R., Jones, C., Jacklin, K., Walker, J. D., & Green, M. E. (2020). Diabetes during pregnancy and perinatal outcomes among First Nations women in Ontario, 2002/03-2014/15: a population-based cohort study. CMAJ Open, 8(1), E214-E225. https://doi.org/10.9778/cmajo.20190195
Vélez MP, et al. Diabetes During Pregnancy and Perinatal Outcomes Among First Nations Women in Ontario, 2002/03-2014/15: a Population-based Cohort Study. CMAJ open. 2020 Jan-Mar;8(1):E214-E225. PubMed PMID: 32193282.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetes during pregnancy and perinatal outcomes among First Nations women in Ontario, 2002/03-2014/15: a population-based cohort study. AU - Vélez,Maria P, AU - Slater,Morgan, AU - Griffiths,Rebecca, AU - Shah,Baiju R, AU - Sutherland,Roseanne, AU - Jones,Carmen, AU - Jacklin,Kristen, AU - Walker,Jennifer D, AU - Green,Michael E, Y1 - 2020/03/19/ PY - 2020/3/21/entrez PY - 2020/3/21/pubmed PY - 2020/3/21/medline SP - E214 EP - E225 JF - CMAJ open VL - 8 IS - 1 N2 - BACKGROUND: In Canada, increasing numbers of women, especially First Nations women, are affected by diabetes during pregnancy, which is a major risk factor for adverse maternal and neonatal outcomes. The aim of this study was to examine temporal trends in pregnancy outcomes and use of health care services in a population-based cohort of First Nations women compared to other women in Ontario according to diabetes status during pregnancy. METHODS: Using health administrative databases, we created annual cohorts of pregnant women from 2002/03 to 2014/15 and identified those with preexisting diabetes and gestational diabetes. We used the Indian Register to identify First Nations women. We estimated rates of adverse maternal and infant outcomes, and measures of use of health care services in each population. RESULTS: There were 1 671 337 deliveries among 1 065 950 women during the study period; of these deliveries, 31 417 (1.9%) were in First Nations women, and 1 639 920 (98.1%) were in other women. First Nations women had a higher prevalence of preexisting diabetes and gestational diabetes than other women in Ontario. First Nations women with preexisting diabetes had higher rates of preeclampsia (3.2%-5.6%), labour induction (33.4%-42.9%) and cesarean delivery (47.8%-53.7%) than other women in Ontario, as did First Nations women with gestational diabetes (3.2%-4.7%, 38.5%-46.9% and 41.4%-43.4%, respectively). The rate of preterm birth was similar between First Nations women and other women in Ontario. Although First Nations women had a higher rate of babies who were large for gestational age than other women, regardless of diabetes status, obstructed labour rates were similar for the 2 cohorts. Almost all First Nations women, regardless of diabetes status, were seen by a primary care provider during their pregnancy, but rates of use of specialty care were lower for First Nations women than for other women. Fifteen percent of all pregnant women with preexisting diabetes visited an ophthalmologist during their pregnancy. INTERPRETATION: Our results confirm disparities in maternal and neonatal outcomes between First Nations women and other women in Ontario. Access to primary care for pregnant women seemed adequate, but access to specialized care, especially for women with preexisting diabetes, needs to improve. SN - 2291-0026 UR - https://www.unboundmedicine.com/medline/citation/32193282/Diabetes_during_pregnancy_and_perinatal_outcomes_among_First_Nations_women_in_Ontario_2002/03_2014/15:_a_population_based_cohort_study_ L2 - http://cmajopen.ca/cgi/pmidlookup?view=long&pmid=32193282 DB - PRIME DP - Unbound Medicine ER -
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