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

Marwan Awad Ahmed; Helen D Bailey; Gavin Pereira; Scott W White; Kingsley Wong; Bridgette J McNamara; Paul Rheeder; Rhonda Marriott; Carrington C J Shepherd

doi:10.1093/ije/dyad072

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

Int J Epidemiol. 2023 Oct 5;52(5):1400-1413. doi: 10.1093/ije/dyad072.

Authors

Marwan Awad Ahmed^{1

2}, Helen D Bailey^{1

3}, Gavin Pereira^{4

5

6}, Scott W White^{7

8}, Kingsley Wong^{1

4}, Bridgette J McNamara⁹, Paul Rheeder¹⁰, Rhonda Marriott¹¹, Carrington C J Shepherd^{1

3

11}

Affiliations

¹ Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
² School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
³ Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
⁴ Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
⁵ Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway.
⁶ enAble Institute, Curtin University, Perth, Western Australia, Australia.
⁷ Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.
⁸ Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
⁹ Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.
¹⁰ Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
¹¹ Ngangk Yira Research Centre, Murdoch University, Perth, Western Australia, Australia.

PMID: 37263617
DOI: 10.1093/ije/dyad072

Abstract

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.

Keywords: Aboriginal; Diabetes in pregnancy; Indigenous Australians; gestational diabetes; neonatal outcomes; pre-gestational diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australian Aboriginal and Torres Strait Islander Peoples
Diabetes, Gestational* / epidemiology
Female
Fetal Macrosomia / epidemiology
Humans
Infant, Newborn
Pregnancy
Pregnancy Complications* / ethnology
Pregnancy Outcome
Pregnancy in Diabetics* / epidemiology
Retrospective Studies
Shoulder Dystocia
Western Australia / epidemiology