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Estimating the Recurrence Rate of Gestational Diabetes Mellitus (GDM) in Massachusetts 1998–2007: Methods and Findings

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Abstract

Objectives

Women with gestational diabetes mellitus (GDM) may be able to reduce their risk of recurrent GDM and progression to type 2 diabetes mellitus through lifestyle change; however, there is limited population-based information on GDM recurrence rates.

Methods

We used data from a population of women delivering two sequential live singleton infants in Massachusetts (1998–2007) to estimate the prevalence of chronic diabetes mellitus (CDM) and GDM in parity one pregnancies and recurrence of GDM and progression from GDM to CDM in parity two pregnancies. We examined four diabetes classification approaches; birth certificate (BC) data alone, hospital discharge (HD) data alone, both sources hierarchically combined with a diagnosis of CDM from either source taking priority over a diagnosis of GDM, and both sources combined including only pregnancies with full agreement in diagnosis. Descriptive statistics were used to describe population characteristics, prevalence of CDM and GDM, and recurrence of diabetes in successive pregnancies. Diabetes classification agreement was assessed using the Kappa statistic. Associated maternal characteristics were examined through adjusted model-based t tests and Chi square tests.

Results

A total of 134,670 women with two sequential deliveries of parities one and two were identified. While there was only slight agreement on GDM classification across HD and BC records, estimates of GDM recurrence were fairly consistent; nearly half of women with GDM in their parity one pregnancy developed GDM in their subsequent pregnancy. While estimates of progression from GDM to CDM across sequential pregnancies were more variable, all approaches yielded estimates of ≤5 %. The development of either GDM or CDM following a parity one pregnancy with no diagnosis of diabetes was <3 % across approaches. Women with recurrent GDM were disproportionately older and foreign born.

Conclusion

Recurrent GDM is a serious life course public health issue; the inter-pregnancy interval provides an important window for diabetes prevention.

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Authors and Affiliations

  1. Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-79, Atlanta, GA, 30341, USA

    Lucinda England & Shin Y. Kim

  2. MGH Center for Child and Adolescent Health Research and Policy, MassGeneral Hospital for Children, Harvard Medical School, 100 Cambridge Street, Room 15-1545, Boston, MA, 02115, USA

    Milton Kotelchuck

  3. DB Consulting Group, Inc., 8403 Colesville Road, Silver Spring, MD, 20910, USA

    Hoyt G. Wilson

  4. Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108, USA

    Hafsatou Diop & Xiaohui Cui

  5. Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108, USA

    Paul Oppedisano

  6. Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F74, Atlanta, GA, 30341-3717, USA

    Carrie K. Shapiro-Mendoza

Authors
  1. Lucinda England
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  2. Milton Kotelchuck
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  3. Hoyt G. Wilson
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Correspondence to Milton Kotelchuck.

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England, L., Kotelchuck, M., Wilson, H.G. et al. Estimating the Recurrence Rate of Gestational Diabetes Mellitus (GDM) in Massachusetts 1998–2007: Methods and Findings. Matern Child Health J 19, 2303–2313 (2015). https://doi.org/10.1007/s10995-015-1750-x

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  • DOI: https://doi.org/10.1007/s10995-015-1750-x

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