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Background <p>Gestational diabetes mellitus (GDM) is associated with adverse pregnancy and birth complications. Asian populations have the highest risk of GDM, with even greater risk among foreign-born (FB) residents. Socio-political factors, such as heightened anti-Asian racism and travel restrictions during COVID19 may have further increased their risk of GDM. Our study sought to examine the associations between race/ethnicity, nativity status, and GDM rate and changes during COVID19.</p> Methods <p>We used the US National Center for Health Statistics natality administrative data (N = 14,219,719). We estimated GDM and birth rates by race/ethnicity (Asian non-Hispanic [NH], Native Hawaiian/Pacific Islander NH, American Indian and Alaska Native NH, Black NH, White NH, Multiracial NH, and Hispanic/Latina) and nativity status (US-born, Foreign-born). Race/ethnicity was evaluated as a social construct for racial discrimination and nativity was evaluated as a proxy for acculturation-related risk factors. We used multivariable robust Poisson regressions to estimate GDM rates per 100 live births for each racial/ethnic group pre-COVID19 (2018–2019) and during COVID19 (2021) by FB status, adjusting for socioeconomic and major pregnancy risk factors.</p> Results <p>In adjusted models, both Asian NH and foreign-born persons had higher rates of GDM compared to White NH (rate ratio [RR]: 2.02, 95% confidence interval [CI]: 2.01, 2.04) and US-born (RR; 1.33, 95% CI: 1.32, 1.34) persons, respectively. Overall GDM rates increased significantly during COVID19 (RR: 1.18, 95% CI: 1.17, 1.18), with Asian US- and foreign-born persons experiencing the greatest absolute increase (US-born: +2.5, 95% CI: 2.4, 2.6; foreign-born: +3.6, 95% CI: 3.5, 3.6) compared to other racial/ethnic groups (US-born: range +1.3–1.7, foreign-born range: +0.5–2.9). Disaggregated by Asian ethnicity, Chinese and Vietnamese persons had the highest GDM rates overall and the greatest increase during COVID19.</p> Conclusion <p>We found significant disparities in GDM rates by race/ethnicity and nativity status between 2018 and 2021, with Asian and foreign-born persons having the highest rates of GDM. Investigation into potential socio-political and other contributing factors of reproductive health inequities during COVID19 may help explain these disparities.</p>

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Racial/Ethnic and Nativity Disparities in Gestational Diabetes Mellitus, United States 2018–2021

  • 期刊论文

  • 发表日期：

    2025年3月13日

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  • Min Kyung Kim,
  • Tamarra M. James-Todd,
  • Lucy Chie,
  • Erika F. Werner,
  • MyDzung T. Chu

摘要

Background

Gestational diabetes mellitus (GDM) is associated with adverse pregnancy and birth complications. Asian populations have the highest risk of GDM, with even greater risk among foreign-born (FB) residents. Socio-political factors, such as heightened anti-Asian racism and travel restrictions during COVID19 may have further increased their risk of GDM. Our study sought to examine the associations between race/ethnicity, nativity status, and GDM rate and changes during COVID19.

Methods

We used the US National Center for Health Statistics natality administrative data (N = 14,219,719). We estimated GDM and birth rates by race/ethnicity (Asian non-Hispanic [NH], Native Hawaiian/Pacific Islander NH, American Indian and Alaska Native NH, Black NH, White NH, Multiracial NH, and Hispanic/Latina) and nativity status (US-born, Foreign-born). Race/ethnicity was evaluated as a social construct for racial discrimination and nativity was evaluated as a proxy for acculturation-related risk factors. We used multivariable robust Poisson regressions to estimate GDM rates per 100 live births for each racial/ethnic group pre-COVID19 (2018–2019) and during COVID19 (2021) by FB status, adjusting for socioeconomic and major pregnancy risk factors.

Results

In adjusted models, both Asian NH and foreign-born persons had higher rates of GDM compared to White NH (rate ratio [RR]: 2.02, 95% confidence interval [CI]: 2.01, 2.04) and US-born (RR; 1.33, 95% CI: 1.32, 1.34) persons, respectively. Overall GDM rates increased significantly during COVID19 (RR: 1.18, 95% CI: 1.17, 1.18), with Asian US- and foreign-born persons experiencing the greatest absolute increase (US-born: +2.5, 95% CI: 2.4, 2.6; foreign-born: +3.6, 95% CI: 3.5, 3.6) compared to other racial/ethnic groups (US-born: range +1.3–1.7, foreign-born range: +0.5–2.9). Disaggregated by Asian ethnicity, Chinese and Vietnamese persons had the highest GDM rates overall and the greatest increase during COVID19.

Conclusion

We found significant disparities in GDM rates by race/ethnicity and nativity status between 2018 and 2021, with Asian and foreign-born persons having the highest rates of GDM. Investigation into potential socio-political and other contributing factors of reproductive health inequities during COVID19 may help explain these disparities.