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Race/Ethnicity, Educational Attainment, and Pregnancy Complications in N ew Y ork C ity Women with Pre‐existing Diabetes
Author(s) -
JamesTodd Tamarra,
Janevic Teresa,
Brown Florence M.,
Savitz David A.
Publication year - 2014
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12100
Subject(s) - medicine , birth certificate , pregnancy , odds ratio , gestational diabetes , confidence interval , obstetrics , diabetes mellitus , eclampsia , small for gestational age , gestational age , gestation , demography , population , endocrinology , environmental health , genetics , sociology , biology
Background More women are entering pregnancy with pre‐existing diabetes. Disease severity, glycaemic control, and predictors of pregnancy complications may differ by race/ethnicity or educational attainment, leading to differences in adverse pregnancy outcomes. Methods We used linked N ew Y ork C ity hospital record and birth certificate data for 6291 singleton births among women with pre‐existing diabetes between 1995 and 2003. We defined maternal race/ethnicity as non‐ H ispanic white, non‐ H ispanic black, H ispanic, S outh A sian, and E ast A sian, and education level as <12, 12, and >12 years. Our outcomes were pre‐eclampsia, preterm birth ( PTB ) (<37 weeks gestation and categorised as spontaneous or medically indicated), as well as small‐for‐gestational age ( SGA ) and large‐for‐gestational age ( LGA ). Using multivariable binomial regression, we estimated the risk ratios for pre‐eclampsia, SGA , and LGA . We used multivariable multinomial regression to estimate odds ratios (OR) for PTB . Results Compared with non‐Hispanic white women with pre‐existing diabetes, non‐ H ispanic black and H ispanic women with pre‐existing diabetes had a 1.50‐fold increased risk of pre‐eclampsia compared with non‐ H ispanic whites with pre‐existing diabetes, after full adjustment. Non‐ H ispanic black and H ispanic women with pre‐existing diabetes had adjusted ORs of 1.72 [adj. 95% confidence interval ( CI ) 1.38, 2.15] and 1.65 [adj.95% CI 1.32, 2.05], respectively, for medically indicated PTB . S outh A sian women with pre‐existing diabetes had the highest risk for having an SGA infant [adj. OR : 2.29; adj. 95% CI 1.73, 3.03]. E ast A sian ethnicity was not associated with these pregnancy complications. Conclusions Non‐ H ispanic black, H ispanic, and S outh A sian women with pre‐existing diabetes may benefit from targeted interventions to improve pregnancy outcomes.