Abstract
BackgroundQuantile regression, a robust semi-parametric approach, was used to examine the impact of gestational diabetes mellitus (GDM) across birthweight quantiles with a focus on maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG).MethodsUsing linked birth certificate, inpatient hospital and prenatal claims data we examined live singleton births to non-Hispanic white (NHW, 135,119) and non-Hispanic black (NHB, 76,675) women in South Carolina who delivered 28–44 weeks gestation in 2004–2008.ResultsAt a maternal BMI of 30 kg/m2 at the 90th quantile of birthweight, exposure to GDM was associated with birthweights 84 grams (95% CI 57, 112) higher in NHW and 132 grams (95% CI: 104, 161) higher in NHB. Results at the 50th quantile were 34 grams (95% CI: 17, 51) and 78 grams (95% CI: 56, 100), respectively. At a maternal GWG of 13.5 kg at the 90th quantile of birthweight, exposure to GDM was associated with birthweights 83 grams (95% CI: 57, 109) higher in NHW and 135 grams (95% CI: 103, 167) higher in NHB. Results at the 50th quantile were 55 grams (95% CI: 40, 71) and 69 grams (95% CI: 46, 92), respectively.SummaryOur findings indicate that GDM, maternal prepregnancy BMI and GWG increase birthweight more in NHW and NHB infants who are already at the greatest risk of macrosomia or being large for gestational age (LGA), that is those at the 90th rather than the median of the birthweight distribution.
Highlights
Obesity prior to pregnancy and high gestational weight gain (GWG) predispose women to gestational diabetes mellitus (GDM) and early onset type 2 diabetes[1,2,3,4]
In a previous analysis of South Carolina births 2004 through 2008 using standard regression methodology we reported a differential impact of GDM on racial differences in birthweight [14]
We reported that at a delivery body mass index (BMI) of 35 kg/m2, GDM exposure was associated with an average birthweight only 17 grams higher in non-Hispanic whites (NHW), but 78 grams higher in non-Hispanic-Blacks (NHB)
Summary
Obesity prior to pregnancy and high gestational weight gain (GWG) predispose women to gestational diabetes mellitus (GDM) and early onset type 2 diabetes[1,2,3,4]. High GWG and diabetes during pregnancy are modifiable risk factors that determine birthweight for gestational age. As hypothesized, the racial differences due to GDM have a greater impact in neonates already predisposed to be LGA, the estimates from standard regression models will underestimate this effect. A robust semi-parametric approach, was used to examine the impact of gestational diabetes mellitus (GDM) across birthweight quantiles with a focus on maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG)
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