Overweight/obesity and other predictors of gestational diabetes among Aboriginal and non-Aboriginal women in Western Australia

Marwan Awad Ahmed; Helen D Bailey; Gavin Pereira; Scott W White; Matthew J L Hare; Kingsley Wong; Rhonda Marriott; Carrington C J Shepherd

doi:10.1016/j.pmedr.2023.102444

Overweight/obesity and other predictors of gestational diabetes among Aboriginal and non-Aboriginal women in Western Australia

Prev Med Rep. 2023 Sep 25:36:102444. doi: 10.1016/j.pmedr.2023.102444. eCollection 2023 Dec.

Authors

Marwan Awad Ahmed^{1

2}, Helen D Bailey^{1

3}, Gavin Pereira^{4

5

6}, Scott W White^{7

8}, Matthew J L Hare^{9

10}, Kingsley Wong^{1

4}, Rhonda Marriott¹¹, Carrington C J Shepherd^{1

3

11}

Affiliations

¹ Telethon Kids Institute, University of Western Australia, Perth, Australia.
² School of Population and Global Health, The University of Western Australia, Perth, Australia.
³ Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, 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, WA, Australia.
⁸ Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia.
⁹ Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
¹⁰ Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
¹¹ Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia.

Abstract

This population-based study investigated the association of BMI and other predictors with gestational diabetes mellitus (GDM) among Australian Aboriginal and non-Aboriginal mothers. We conducted a state-wide retrospective cohort study that included all singleton births in Western Australia (n = 134,552) between 2012 and 2015 using population health datasets linked by the Western Australian Data Linkage Branch. Associations between GDM and its predictors were estimated as adjusted relative risks (aRRs) from multivariable generalised linear models. Adjusted ratio of relative risks (aRRRs) compared RRs in Aboriginal and non-Aboriginal mothers. Adjusted population attributable fractions estimated the contribution of overweight/obesity to GDM burden, and adjusted predicted probabilities for GDM were plotted against BMI levels. The following predictors had stronger associations with GDM in Aboriginal, compared to non-Aboriginal, mothers: maternal obesity (aRR [95% CI] 3.16 [2.54-3.93]; aRRR 1.57 [1.26-1.94]), previous LGA (aRR 1.70 [1.37-2.12]; aRRR 1.41 [1.13-1.76]) and previous macrosomia (birthweight ≥ 4 kg) (aRR 1.55 [1.24-1.94]; aRRR 1.53 [1.22-1.91]). 46.1% (95% CI: 36.6-54.1) of GDM cases in Aboriginal women (23.3% in non-Aboriginal mothers, 95% CI: 21.6-25.1) were attributed to overweight/obesity. Compared to non-Aboriginal mothers, adjusted GDM probabilities were higher at all BMI levels and showed greater increase with BMI. Overweight/obesity is a key driver of GDM among Aboriginal women. Association between BMI and GDM is stronger in Aboriginal, compared to non-Aboriginal, women especially at higher BMI.

Keywords: Aboriginal; Body mass index; Gestational diabetes; Indigenous Australians; Obesity; Overweight; Population attributable fraction.