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The impact of diabetes during pregnancy on neonatal outcomes among the Aboriginal population in Western Australia: a whole-population study.

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  • معلومة اضافية
    • المصدر:
      Publisher: Oxford University Press Country of Publication: England NLM ID: 7802871 Publication Model: Print Cited Medium: Internet ISSN: 1464-3685 (Electronic) Linking ISSN: 03005771 NLM ISO Abbreviation: Int J Epidemiol Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: [London] Oxford University Press.
    • الموضوع:
      Diabetes, Gestational*/epidemiology ; Pregnancy in Diabetics*/epidemiology ; Pregnancy Complications*/ethnology; Female ; Humans ; Infant, Newborn ; Pregnancy ; Fetal Macrosomia/epidemiology ; Retrospective Studies ; Shoulder Dystocia ; Western Australia/epidemiology ; Australian Aboriginal and Torres Strait Islander Peoples ; Pregnancy Outcome
    • نبذة مختصرة :
      Background: Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have a high prevalence of diabetes in pregnancy (DIP), which includes pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). We aimed to characterize the impact of DIP in babies born to Aboriginal mothers.
      Methods: A retrospective cohort study, using routinely collected linked health data that included all singleton births (N = 510 761) in Western Australia between 1998 and 2015. Stratified by Aboriginal status, generalized linear mixed models quantified the impact of DIP on neonatal outcomes, estimating relative risks (RRs) with 95% CIs. Ratio of RRs (RRRs) examined whether RRs differed between Aboriginal and non-Aboriginal populations.
      Results: Exposure to DIP increased the risk of adverse outcomes to a greater extent in Aboriginal babies. PGDM heightened the risk of large for gestational age (LGA) (RR: 4.10, 95% CI: 3.56-4.72; RRR: 1.25, 95% CI: 1.09-1.43), macrosomia (RR: 2.03, 95% CI: 1.67-2.48; RRR: 1.39, 95% CI: 1.14-1.69), shoulder dystocia (RR: 4.51, 95% CI: 3.14-6.49; RRR: 2.19, 95% CI: 1.44-3.33) and major congenital anomalies (RR: 2.14, 95% CI: 1.68-2.74; RRR: 1.62, 95% CI: 1.24-2.10). GDM increased the risk of LGA (RR: 2.63, 95% CI: 2.36-2.94; RRR: 2.00, 95% CI: 1.80-2.22), macrosomia (RR: 1.95, 95% CI: 1.72-2.21; RRR: 2.27, 95% CI: 2.01-2.56) and shoulder dystocia (RR: 2.78, 95% CI: 2.12-3.63; RRR: 2.11, 95% CI: 1.61-2.77). Birthweight mediated about half of the DIP effect on shoulder dystocia only in the Aboriginal babies.
      Conclusions: DIP differentially increased the risks of fetal overgrowth, shoulder dystocia and congenital anomalies in Aboriginal babies. Improving care for Aboriginal women with diabetes and further research on preventing shoulder dystocia among these women can reduce the disparities.
      (© The Author(s) 2023; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)
    • Contributed Indexing:
      Keywords: Aboriginal; Diabetes in pregnancy; Indigenous Australians; gestational diabetes; neonatal outcomes; pre-gestational diabetes
    • الموضوع:
      Date Created: 20230601 Date Completed: 20231025 Latest Revision: 20231025
    • الموضوع:
      20250114
    • الرقم المعرف:
      10.1093/ije/dyad072
    • الرقم المعرف:
      37263617