Rates of Gestational Diabetes on the Rise Among First-Time Mothers in the US

Sadiya Khan, MD

New research Is sounding the alarm on increased rates of gestational diabetes among first-time mothers in the US.

Conducted by investigators from Northwestern University, Kaiser Permanente, and the Centers for Disease Control and Prevention, the cross-sectional analysis of data from 12.6 million singleton births suggests the rate of gestational diabetes has increased from 47.6 per 1000 live births in 2011 to 63.5 per 1000 live births in 2019, with increases in prevalence observed across all racial and ethnic subgroups included in the analysis.

“Given that gestational diabetes is associated with increased short-term and long-term risks for individuals and their offspring, the observed trends and disparities may portend a greater burden of future cardiometabolic disease,” wrote investigators.

With the increased risk of Cardiometabolic conditions associated with gestational diabetes widely recognized, a team of investigators led by Sadiya Khan, MD, MSc, assistant professor at Northwestern University Feinberg School of Medicine, conducted the present study to develop a greater understanding of contemporary trends in the rate of gestational diabetes among individuals at first live births between 2011 and 2019. To do so, investigators designed their study as a serial cross-sectional analysis of information from the National Center for Health Statistics (NCHS).

From the NCHS, investigators identified 12,610,235 individuals aged 15-44 years with singleton live birth from 2011-2019. For the purpose of analysis, these patients were stratified into the following groups: Hispanic/Latina, non-Hispanic Asian/Pacific Island, non-Hispanic Black, and non-Hispanic White. Of note, the Hispanic/Latina group included those identifying Central and South American, Cuban, Mexican, and Puerto Rican and the non-Hispanic Asian/Pacific Islander group included those identifying as Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese.

The primary outcomes of interest for the analysis were the age-standardized rates of gestational diabetes per 1000 live births and respective mean annual percent change and rate ratios of gestational diabetes among the aforementioned groups and subgroups relative to those in the non-Hispanic White group.

The 12,610,235 individuals included in the analysis had a mean age of 26.5 (SD, 5.8) years, 21% were Hispanic/Latina, 8% were non-Hispanic Asian/Pacific Islander, 14% were non-Hispanic Black, and 56% were non-Hispanic White. Overall, the age-standardized gestational diabetes rates increased from 47.6 (95% CI, 47.1-48.0) per 1000 live births in 2011 to 63.5 (95% CI, 63.1-64.0) per 1000 live births in 2019, which represents a mean annual percent change of 3.7% (95% CI, 2.8-4.6%) per year.

In analyses of subgroups based on race, increases were observed across all groups from 2011 to 2019. Investigators noted rates were greatest among Asian Indian patients, with a rate of 129.1 (95% CI, 100.7-104.7) per 1000 live births. Investigators also pointed out rates were greatest among Puerto Rican (75.8 per 1000 live births [95% CI, 71.8-79.9]) patients than any other Hispanic/Latina subgroup.

In an editorial comment, Camille Powe, MD, and Ebony Carter, MD, MPH, express their concern over the rising rates of gestational diabetes and potential racial and ethnic barriers to care.

“The study by Shah et aldocuments a concerning trend of increasing gestational diabetes rates over the past decade, as well as persistent racial and ethnic inequities in gestational diabetes prevalence. Because of the strong links between glucose intolerance during pregnancy and future diabetes, these observations ominously foreshadow a potential future increase in diabetes incidence” wrote Powe and Carter.

This study, “Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019,” was published in JAMA.