Differential Effect of Nativity on Type 2 Diabetes Diagnosis Post-Gestational Diabetes, by Race/Ethnicity

Abstract

Background: Women with GDM have seven times higher risk of T2D compared to women with normoglycaemic pregnancies, with black women having the highest risk. Immigrants are a growing share of the U.S. population, with approximately 9% of the black population and 34% of Hispanic population being foreign-born. Due to differences in acculturation and assimilation, foreign-born U.S. women experience different pregnancy-related outcomes and subsequent chronic disease development, depending on their race/ethnicity. Objective: To examine the association between nativity and T2D diagnosis following a prior GDM pregnancy and whether this association differs by racial/ethnic group. Methods: We conducted a cross-sectional analysis of data from the 2007-2014 National Health and Nutrition Examination Survey, a nationally representative survey of non-institutionalized Americans. The analytic population included women with at least one prior GDM pregnancy. Logistic regression (OR, 95% CI) was used to examine the association. Results: Our final sample included 433 women. The population was predominantly non-Hispanic white (62%), followed by Hispanic (18%) and black (12%). T2D was found in 29% of the population. After controlling for confounders, foreign-born black women had 0.14 (0.02-0.82) times the odds of developing T2D post GDM compared to black U.S. born women. Nativity was not significantly associated with cumulative incidence of T2D among Hispanics (1.45, 0.48-4.41) or non-Hispanic whites (1.53, 0.04,-6.07). Conclusion: We found differential effects of nativity across racial/ethnic groups consistent with prior literature. Among black women, being foreign-born significantly decreases the odds of developing T2D following a GDM pregnancy but not among other groups. This observed effect may be due to U.S. born black women experiencing higher levels of racialized and gendered stress, both associated with higher levels of inflammation that can lead to higher risk of T2D. Disclosure B. Butler: None. P. Salsberry: None. J.K. Bower: None.