Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996–2014 - 09/11/16

Doi : 10.1016/j.ajog.2016.10.007

Tiffany Y. Peng, MA ^a, Samantha F. Ehrlich, PhD, MPH ^a,^b, Yvonne Crites, MD ^c, John L. Kitzmiller, MD, MS ^d, Michael W. Kuzniewicz, MD, MPH ^a, Monique M. Hedderson, PhD, MPH ^a, Assiamira Ferrara, MD, PhD ^a,^⁎
^a Division of Research, Kaiser Permanente of Northern California, Oakland, CA
^b Department of Public Health, University of Tennessee Knoxville, Knoxville, TN
^c Division of Perinatology, Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara, CA
^d Division of Maternal-Fetal Medicine, Santa Clara Valley Medical Center, San Jose, CA

^∗Corresponding author: Assiamira Ferrara, MD, PhD.

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Abstract

Background

Despite concern for adverse perinatal outcomes in women with diabetes mellitus before pregnancy, recent data on the prevalence of pregestational type 1 and type 2 diabetes mellitus in the United States are lacking.

Objective

The purpose of this study was to estimate changes in the prevalence of overall pregestational diabetes mellitus (all types) and pregestational type 1 and type 2 diabetes mellitus and to estimate whether changes varied by race-ethnicity from 1996–2014.

Study Design

We conducted a cohort study among 655,428 pregnancies at a Northern California integrated health delivery system from 1996–2014. Logistic regression analyses provided estimates of prevalence and trends.

Results

The age-adjusted prevalence (per 100 deliveries) of overall pregestational diabetes mellitus increased from 1996–1999 to 2012–2014 (from 0.58 [95% confidence interval, 0.54–0.63] to 1.06 [95% confidence interval, 1.00–1.12]; P_trend <.0001). Significant increases occurred in all racial-ethnic groups; the largest relative increase was among Hispanic women (121.8% [95% confidence interval, 84.4–166.7]); the smallest relative increase was among non-Hispanic white women (49.6% [95% confidence interval, 27.5–75.4]). The age-adjusted prevalence of pregestational type 1 and type 2 diabetes mellitus increased from 0.14 (95% confidence interval, 0.12–0.16) to 0.23 (95% confidence interval, 0.21–0.27; P_trend <.0001) and from 0.42 (95% confidence interval, 0.38–0.46) to 0.78 (95% confidence interval, 0.73–0.83; P_trend <.0001), respectively. The greatest relative increase in the prevalence of type 1 diabetes mellitus was in non-Hispanic white women (118.4% [95% confidence interval, 70.0–180.5]), who had the lowest increases in the prevalence of type 2 diabetes mellitus (13.6% [95% confidence interval, –8.0 to 40.1]). The greatest relative increase in the prevalence of type 2 diabetes mellitus was in Hispanic women (125.2% [95% confidence interval, 84.8–174.4]), followed by African American women (102.0% [95% confidence interval, 38.3–194.3]) and Asian women (93.3% [95% confidence interval, 48.9–150.9]).

Conclusions

The prevalence of overall pregestational diabetes mellitus and pregestational type 1 and type 2 diabetes mellitus increased from 1996–1999 to 2012–2014 and racial-ethnic disparities were observed, possibly because of differing prevalence of maternal obesity. Targeted prevention efforts, preconception care, and disease management strategies are needed to reduce the burden of diabetes mellitus and its sequelae.

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Key words : diabetes mellitus, pregnancy, prevalence, racial-ethnic disparities

Plan

Materials and Methods

Statistical analyses

Results

Comments

	Supported by a from grant P30 DK092924 from the National Institute of Diabetes and Digestive and Kidney Diseases (A.F.) and by K01DK105106 from the National Institute of Diabetes and Digestive and Kidney Diseases (S.F.E.).
	The study sponsors were not involved in the study design; data collection, analysis, and interpretation; writing of the report; or the decision to submit the manuscript for publication.
	The authors report no conflict of interest.
	Cite this article as: Peng TY, Ehrlich SF, Crites Y, et al. Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996–2014. Am J Obstet Gynecol 2016;•••:••••.