Abstract
BackgroundDespite the disproportionate prevalence of gestational diabetes (GDM) and preterm birth (PTB) and their associated adverse perinatal outcomes among Black women, little is known about PTB among Black women with GDM. Specifically, the relationship between PTB by subtype (defined as indicated PTB and spontaneous PT labor) and severity, GDM, and nativity has not been well characterized. Here we examine the risk of PTB by severity (early < 34 weeks, late 34 to 36 weeks) and early term birth (37 to 38 weeks) by nativity among Black women with GDM in California.MethodsThis retrospective cohort study used linked birth certificate and hospital discharge data for 8609 of the 100,691 self-identifying non-Hispanic Black women with GDM who had a singleton live birth between 20 and 44 weeks gestation in California in 2013–2017. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were examine risks for PTB, by severity and subtype, and early term birth using multivariate regression modeling.ResultsApproximately, 83.9% of Black women with GDM were US-born and 16.1% were foreign-born. The overall prevalence of early PTB, late PTB, and early term birth was 3.8, 9.5, and 29.9%, respectively. Excluding history of prior PTB, preeclampsia was the greatest overall risk factor for early PTB (cOR = 6.7, 95%, CI 5.3 to 8.3), late PTB (cOR = 4.3, 95%, CI 3.8 to 5.0), and early term birth (cOR = 1.8, 95%, CI 1.6 to 2.0). There was no significant difference in the prevalence of PTB by subtypes and nativity (p = 0.5963). Overall, 14.2% of US- compared to 8.9% of foreign-born women had a PTB (early PTB: aOR = 0.56, 95%, CI 0.38 to 0.82; late PTB: aOR = 0.57, 95%, CI 0.45 to 0.73; early term birth: aOR = 0.67, 95%, CI 0.58 to 0.77).ConclusionsForeign-born status remained protective of PTB, irrespective of severity and subtype. Preeclampsia, PTB, and GDM share pathophysiologic mechanisms suggesting a need to better understand differences in perinatal stress, chronic disease, and vascular dysfunction based on nativity in future epidemiologic studies and health services research.
Highlights
Despite the disproportionate prevalence of gestational diabetes (GDM) and preterm birth (PTB) and their associated adverse perinatal outcomes among Black women, little is known about PTB among Black women with gestational diabetes mellitus (GDM)
This study serves as a building block for epidemiologists, clinicians, and clinician scientists, and suggests that PTB and early term birth may be in part due to chronic inflammation or vasculature dysfunction in response to chronic life stressors
Prospective, and longitudinal research would benefit from a focus on measures of acculturation, life course experience of structural and interpersonal gendered racism and other stressors, biomarkers, and glycemic control in order to gain a fuller understanding of PTB and early term birth drivers
Summary
Despite the disproportionate prevalence of gestational diabetes (GDM) and preterm birth (PTB) and their associated adverse perinatal outcomes among Black women, little is known about PTB among Black women with GDM. We examine the risk of PTB by severity (early < 34 weeks, late 34 to 36 weeks) and early term birth (37 to 38 weeks) by nativity among Black women with GDM in California. GDM, like preterm birth (PTB, < 37 weeks), disproportionately develops in the pregnancies of Black women [3] and significantly contributes to both maternal and infant mortality and morbidity [4,5,6]. PTB outcomes in pregnancies affected by GDM remains unexplained in published literature, in Black women. Risk of PTB and GDM among Black women differs by one notable risk factor, namely maternal country of origin or nativity. The protective effect of foreign birth outside of the U.S has been attributed to a phenomenon called the healthy migrant theory [14], which describes how foreign-born persons who migrate to the U.S have significantly better health outcomes in comparison to U.S.-born persons with the same racial and ethnic identities [15,16,17,18,19]
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