Pregnancy in Motion

Gestational Diabetes Rose by a Third in Eight Years

Between 2011 and 2019, the rate of gestational diabetes rose from 48 to 64 cases per 1,000. The rate rose across all racial and ethnic subgroups. But the risk is highest for Asian Indian individuals – twice the risk in the non-Hispanic White population. These data, published in JAMA this week, raise a note of concern. In an editorial alongside the findings, Camille Powe and Ebony Carter spell it out:

“The study by Shah et al documents a concerning trend of increasing gestational diabetes rates over the past decade, as well as persistent racial and ethnic inequities in gestational diabetes prevalence. Because of the strong links between glucose intolerance during pregnancy and future diabetes these observations ominously foreshadow a potential future increase in diabetes incidence.”

Persistent Disparities

Disparities in the risk of gestational diabetes persisted throughout the study period for all racial and ethnic minorities. One of the key risk factors for gestational diabetes is obesity. Rates of obesity and overweight grew during the study period. But it doesn’t tell the whole story because Asian/Pacific Islander was the primary group with the highest rates of gestational diabetes. Yet this group had the lowest rate of BMI above 25 before pregnancy. It was 26 percent. That compares to 46 percent overall and 45 percent in the non-Hispanic White population. The study authors remind us that usual benchmarks for BMI are not a reliable indicator of visceral fat in Asian populations.

Also noteworthy is the fact that the Black population had the lowest rate of gestational diabetes. But this was in part because this group had the highest rate of diabetes before pregnancy. In fact, it more than offset the lower rate of gestational diabetes.

The Context of Systemic Racism and Growing Metabolic Disease

These findings are especially disturbing because of their context. They document persistent disparities in a key indicator of maternal and child health. Gestational diabetes predicts health problems for both mother and child: more risk of diabetes and more risk of heart disease. All this exists in a health system where racism hides in plain sight.

Furthermore, it comes in the context of growing metabolic disease trends that have their roots in growing obesity rates. For four decades now, public health strategies have done little to slow or reverse these trends.

As Powe and Carter aptly write, it’s time to get serious.

Click here for the study and here for the editorial. For further reporting, click here and here.

Pregnancy in Motion, photograph © David Leo Veksler / flickr

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August 20, 2021