The rate of gestational diabetes has shot up 30 percent in young U.S. women over the past decade and more than doubled in U.S. women who identify as Asian-Indian compared with non-Hispanic White women, reports a new Northwestern Medicine study published in JAMA.
This is unacceptably high and alarming. The consistent and continued increase over the last decade could have significant impact on not just pregnancy health and outcomes for the mom and baby, but also long-term health for both. Gestational diabetes is linked to a higher risk of cardiovascular disease for the mom and child."
Sadiya Khan, MD, MSc, Corresponding Author, Assistant Professor of Medicine, Division of Cardiology and Northwestern Medicine Physician
The study also reported that chronic diabetes present prior to pregnancy (Type 1 or 2) rose more than 20 percent since 2011, nearly twice as high in individuals who identified as non-Hispanic Black and Puerto Rican.
"The pandemic year could push these gestational diabetes numbers even higher due to lifestyle changes in exercise, eating and increased stress," Khan said.
Gestational diabetes is associated with maternal mortality and morbidity, meaning there is a higher risk of women dying in pregnancy and of serious complications during pregnancy and delivery. These include: needing to go to the Intensive Care Unit during pregnancy or birth, significant blood loss during birth and having a C-section.
Long-term observational studies also show higher glucose exposure in utero sets the stage for these children to be at higher risk for obesity, heart disease and diabetes later in life.
Growing rates and persistent disparities in maternal morbidity and mortality are a major public health concern in the U.S. While maternal deaths have declined worldwide over the past 30 years, they have increased in the U.S. The U.S. has the highest maternal death rate of any industrialized nation and significant disparities exist.
"The findings are the most comprehensive and contemporary data available that covers all live births in the U.S.," said study first author Nilay Shah, MD, MPH, assistant professor of Medicine in the Division of Cardiology and a Northwestern Medicine physician. "Our evaluation included individuals from subgroups of the Asian American, Pacific Islander and Hispanic populations in the U.S., who too frequently are underrepresented in research and disease surveillance."
Northwestern investigators evaluated data from more than 12.5 million birth certificates from the National Center for Health Statistics for deliveries to individuals at first live birth for ages 15 to 44 in the U.S. between 2011-2019. These data allowed investigators to identify trends in gestational diabetes over time and differences in which groups are most affected. They focused on Asian American and Pacific Islander subgroups, which represent the fastest-growing ethnic group in the U.S. and are among the most underrepresented in research.
"These are strikingly higher rates over such a short time period," Shah said. "We expected it to increase over this time period, but the fact it increased so much, and in every age and race/ethnic group, is very concerning."
Khan, Shah and the study team are now investigating the reason for the increase, which parallels the rise in obesity. The rise in gestational diabetes for U.S. women is likely linked to poor-quality diet, low levels of physical activity and being obese or overweight, they said.
"Earlier diagnosis in pregnancy is one way to identify risk and intervene sooner, as well as focusing on prevention even before pregnancy," Khan said. "We need to emphasize and prioritize women's health not just during pregnancy, but also before and after."
Shah, N.S., et al. (2021) Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019. JAMA. doi.org/10.1001/jama.2021.7217.