Racial and ethnic disparities in extremes of fetal growth after gestational diabetes mellitus
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The aim of this study was to assess and compare risks of having large- or small-for gestational age (LGA and SGA, respectively) infants born to women with gestational diabetes mellitus (GDM) from ten racial/ethnic groups.
LGA and SGA were defined as birthweight >90th and <10th percentile, respectively, specific to each racial/ethnic population and infant sex. Risks of LGA and SGA were compared among a retrospective cohort of 29,544 GDM deliveries from Hispanic, non-Hispanic white (NHW), non-Hispanic black (NHB), Filipino, Chinese, Asian Indian, Vietnamese, Korean, Japanese and Pacific Islander (PI) groups of women.
Unadjusted LGA and SGA risks varied among the ten groups. For LGA, the highest risk was in infants born to NHB women (17.2%), followed by those born to PI (16.2%), Hispanic (14.5%), NHW (13.1%), Asian Indian (12.8%), Filipino (11.6%) and other Asian (9.6–11.1%) women (p < 0.0001). Compared with NHW, the LGA risk was significantly greater for NHB women with GDM (RR 1.25 [95% CI 1.11–1.40]; p = 0.0001 after adjustment for maternal characteristics). Further adjustment for maternal pre-pregnancy BMI and gestational weight gain in the sub-cohort with available data (n = 8,553) greatly attenuated the elevated LGA risk for NHB women. For SGA, the risks ranged from 5.6% to 11.3% (p = 0.003) where most groups (8/10) had risks that were lower than the population-expected 10% and risks were not significantly different from those in NHW women.
These data suggest that variation in extremes of fetal growth associated with GDM deliveries across race/ethnicity can be explained by maternal characteristics, maternal obesity and gestational weight gain. Women should be advised to target a normal weight and appropriate weight gain for pregnancies; this is particularly important for NHB women.
KeywordsFetal growth Gestational diabetes mellitus Large for gestational age infants Racial/ethnic disparity Small for gestational age infants
Electronic medical record
Gestational diabetes mellitus
Kaiser Permanente Southern California
Large for gestational age
Small for gestational age
Some of the data were presented as a poster abstract at the American Diabetes Association 73rd Scientific Sessions meeting in June 2013.
This work was supported by Kaiser Permanente Southern California Direct Community Benefit funds. The funder has no role in the design and conduct of the study; in the collection, analysis and interpretation of the data; or in the preparation, review, or approval of the manuscript.
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
AHX contributed to study conception and design; AHX, MHB, BHL and MPM contributed to data acquisition; AHX, MHB and BHL contributed to data analysis; all authors contributed to interpretation of data; AHX drafted the manuscript; all authors reviewed and revised the manuscript critically for important intellectual content, and all approved the version to be published. AHX is responsible for the integrity of the work as a whole.
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