Racial/Ethnic and Nativity Inequalities in Gestational Diabetes Mellitus: The Role of Psychosocial Stressors.

Abstract

Racial/ethnic and nativity disparities in gestational diabetes mellitus (GDM) persist in the United States. Identified factors associated with these differences do not fully explain them. Research has recognized psychosocial stress as a potentially modifiable risk factor for GDM. We used New York City Pregnancy Risk and Assessment Monitoring System data (2009-2014) linked with birth certificate items (n=7,632) in bivariate and multivariate analyses to examine associations between 12 psychosocial stressors (modeled three ways: individual stressors, grouped stressors, stress constructs) and GDM across race/ethnicity and nativity, and if stressors explain racial/ethnic/nativity differences in GDM. U.S. and foreign-born Black and Hispanic women reported higher stressors relative to U.S.-born White women. In fully adjusted models, the financial stress construct was associated with a 51% increased adjusted risk of GDM, and adding all stressors doubled the risk. Psychosocial stressors did not explain the elevated risk of GDM among foreign-born Black (adjusted risk ratio,2.18; 95% confidence interval, 1.53-3.11), Hispanic (adjusted risk ratio,1.57; 95% confidence interval, 1.10-2.25), or Asian/Pacific Islander (adjusted risk ratio,4.10; 95% confidence interval, 3.04-5.52) women compared with U.S.-born White women. Historically minoritized racial/ethnic and immigrant women have an increased risk of psychosocial stressors and GDM relative to U.S.-born White women. Although financial and all stressors predicted higher risk of GDM, they did not explain the increased risk of GDM among immigrant and minoritized racial/ethnic women. Further examination into racial/ethnic and nativity inequalities in stress exposure and rates of GDM is warranted to promote healthier pregnancies and birth outcomes.