Research
Obstetrics
Gestational diabetes in the United States: temporal trends 1989 through 2004

https://doi.org/10.1016/j.ajog.2007.11.017Get rights and content

Objective

The objective of the study was to characterize trends in gestational diabetes (GDM) by maternal age, race, and geographic region in the United States.

Study Design

The National Hospital Discharge Survey, comprised of births in the United States between 1989 and 2004 (weighted n = 58,922,266), was used to examine trends in GDM, based on an International Classification of Diseases, Ninth Revision, Clinical Modification code of 648.8. We examined temporal trends by comparing GDM rates in the earliest (1989-1990) vs most recent (2003-2004) biennial periods. Relative risks, quantifying racial disparity (black vs white) in GDM, were derived through logistic regression models after adjusting for confounders. These analyses were further stratified by maternal age and geographic region.

Results

Prevalence rates of GDM increased from 1.9% in 1989-1990 to 4.2% in 2003-2004, a relative increase of 122% (95% confidence interval [CI] 120%, 124%). Among whites, GDM increased from 2.2% in 1989-1990 to 4.2% in 2003-2004 (relative increase of 94% [95% CI 91%, 96%]), and this was largely driven by an increase in the 25-34 year age group. In contrast, the largest relative increase in GDM (260% [95% CI 243%, 279%]) among blacks between 1989-1990 (0.6%) and 2003-2004 (2.1%) occurred to women aged younger than 25 years. The black-white disparity in GDM rates widened markedly among women aged younger than 35 years in the 1997-2004 periods. The largest relative increases were seen in the West (182% [95% CI 177%, 187%]) followed by the South and Northeast. The observed increase in GDM rates in the Northeast, Midwest, and South regions most likely is due to increase in GDM prevalence rates among blacks.

Conclusion

This study shows that the prevalence rate of GDM in the United States has increased dramatically between 1989 and 2004. The temporal increase and the widening black-white disparity in the rate of GDM deserves further investigation.

Section snippets

Data source

We used the National Hospital Discharge Survey (NHDS) data that contain maternal hospital discharge records of births in the United States during 1989 to 2004 (weighted n = 58,922,266). The survey is conducted annually by the National Center for Health Statistics of the United States Centers for Disease Control and Prevention. Data on hospital discharges are from short-stay (with an average length of stay of less than 30 days), noninstitutional general hospitals, exclusive of federal, military,

Results

During the study period, the average annual prevalence rate of GDM was 2.9%. The prevalence of GDM increased from 1.9% in 1989-1990 to 4.2% in 2003-2004, a relative increase of 122% (95% CI 120%, 124%). A markedly higher overall prevalence rate (5.8%) was noted among women 35 years old or older (Figure 1) and a relatively lower rate among women aged younger than 25 years (1.4%).

Race- and maternal age-specific GDM rates and temporal changes in rates between the earliest (1989-1990) and most

Comment

The prevalence rate of gestational diabetes more than doubled between 1989-1990 and 2003-2004 in the United States. Although risk for GDM increased with maternal age regardless of maternal race, our study suggests an apparent race disparity in the temporal increase in GDM in the United States.

Our study was not designed to explore the causes for the temporal changes in GDM. Unmeasured factors that may have contributed to the increased prevalence may be the recent surge in obesity among women or

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    Cite this article as: Getahun D, Nath C, Ananth CV, et al. Gestational diabetes in the United States: temporal trends 1989 through 2004. Am J Obstet Gynecol 2008;198:525.e1-525.e5.

    D. G., C.V.A., and J.C.S. are partly supported by a grant from the National Institutes of Health, Bethesda, MD (Grant HD038902 to C.V.A.).

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