Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project

Abstract

ObjectivesBecause of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the 2 populations from 1980 to 2013. MethodsUsing Ministry of Health administrative databases, we examined overall GDM and pre-GDM predictors among a cohort of FN and non-FN women using logistic regression models. We compared early birth complications by ethnicity and DIP status using chi-square analysis. ResultsDeidentified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. Important GDM and pre-GDM predictors for FN and non-FN pregnancies were increasing maternal age, a previous high birthweight (HBW) or stillborn infant, and, most importantly, previous maternal GDM. Both GDM and pre-GDM were over 2.3-fold as likely to occur among FN in multivariable analysis. FN and non-FN pregnancies with GDM and pre-GDM had higher rates of prematurity, shoulder dystocia, caesarean section, HBW and stillborn and infant death than those with no DIP. The largest rate disparities between FN and non-FN with DIP occurred with stillborn, HBW and shoulder dystocia. ConclusionsAlong with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early mother/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in preconception, prenatal and perinatal care, are required to remove ethnicity-based disparities in DIP rates and outcomes.