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
Departments of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, The Ohio State University, Columbus, Ohio, University of Texas Health Science Center at Houston, Houston, Texas, University of Texas Southwestern Medical Center, Dallas, Texas, Columbia University, New York, New York, University of Utah, Salt Lake City, Utah, University of Alabama at Birmingham, Birmingham, Alabama, Drexel University, Philadelphia, Pennsylvania, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio, Wake Forest University Health Sciences, Winston-Salem, North Carolina, University of Texas Medical Branch, Galveston, Texas, University of Pittsburgh, Pittsburgh, Pennsylvania, Wayne State University, Detroit, Michigan, Northwestern University, Chicago, Illinois, and Oregon Health & Science University, Portland, Oregon; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Corresponding author: Erica K. Berggren, MD, Jefferson Medical College of Thomas Jefferson University, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 834 Chestnut Street, Suite 400, Philadelphia, PA 19107; e-mail: firstname.lastname@example.org.
* For a list of other members of the NICHD MFMU, see the Appendix online at http://links.lww.com/AOG/A322.
The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (HD27915, HD34116, HD40485, HD34208, HD27869, HD40500, HD40560, HD34136, HD40544, HD27860, HD40545, HD53097, HD21410, HD27917, HD40512, HD53118, HD36801), General Clinical Research Centers Grant (M01-RR00034), and the National Center for Research Resources (UL1-RR024989, M01-RR00080, UL1-RR025764, C06-RR11234) and does not necessarily represent the official views of the NICHD or the National Institutes of Health (NIH).
The authors thank Francee Johnson, RN, BSN, and Jo-Ann Tillinghast, RN, MSN, for protocol development and coordination between clinical research centers; Elizabeth Thom, PhD, for protocol and data management and statistical analysis; and John M. Thorp, Jr, MD, for protocol development and oversight.
Dr. Spong, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.
Financial Disclosure The authors did not disclose any potential conflicts of interest.