Preterm birth and nativity among Black women with gestational diabetes in California, 2013-2017: a population-based retrospective cohort study

Karen A Scott; Brittany D Chambers; Rebecca J Baer; Kelli K Ryckman; Monica R McLemore; Laura L Jelliffe-Pawlowski

doi:10.1186/s12884-020-03290-3

Preterm birth and nativity among Black women with gestational diabetes in California, 2013-2017: a population-based retrospective cohort study

BMC Pregnancy Childbirth. 2020 Oct 6;20(1):593. doi: 10.1186/s12884-020-03290-3.

Authors

Karen A Scott¹, Brittany D Chambers^{2

3}, Rebecca J Baer^{4

2

5}, Kelli K Ryckman⁶, Monica R McLemore⁷, Laura L Jelliffe-Pawlowski^{2

3}

Affiliations

¹ Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California San Francisco, 2356 Sutter Street, J-140, San Francisco, CA, 94143, USA. karen.scott2@ucsf.edu.
² California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.
³ Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 560 16th Street, Second Floor, San Francisco, CA, 94158, USA.
⁴ Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California San Francisco, 2356 Sutter Street, J-140, San Francisco, CA, 94143, USA.
⁵ Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, Building 3, La Jolla, CA, 92161, USA.
⁶ Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Office S435 CPHB, Iowa City, IA, 52242, USA.
⁷ Family Health Care Nursing Department, School of Nursing, University of California, 2 Koret Way, N431H, San Francisco, San Francisco, CA, 94143, USA.

Abstract

Background: Despite the disproportionate prevalence of gestational diabetes (GDM) and preterm birth (PTB) and their associated adverse perinatal outcomes among Black women, little is known about PTB among Black women with GDM. Specifically, the relationship between PTB by subtype (defined as indicated PTB and spontaneous PT labor) and severity, GDM, and nativity has not been well characterized. Here we examine the risk of PTB by severity (early < 34 weeks, late 34 to 36 weeks) and early term birth (37 to 38 weeks) by nativity among Black women with GDM in California.

Methods: This retrospective cohort study used linked birth certificate and hospital discharge data for 8609 of the 100,691 self-identifying non-Hispanic Black women with GDM who had a singleton live birth between 20 and 44 weeks gestation in California in 2013-2017. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were examine risks for PTB, by severity and subtype, and early term birth using multivariate regression modeling.

Results: Approximately, 83.9% of Black women with GDM were US-born and 16.1% were foreign-born. The overall prevalence of early PTB, late PTB, and early term birth was 3.8, 9.5, and 29.9%, respectively. Excluding history of prior PTB, preeclampsia was the greatest overall risk factor for early PTB (cOR = 6.7, 95%, CI 5.3 to 8.3), late PTB (cOR = 4.3, 95%, CI 3.8 to 5.0), and early term birth (cOR = 1.8, 95%, CI 1.6 to 2.0). There was no significant difference in the prevalence of PTB by subtypes and nativity (p = 0.5963). Overall, 14.2% of US- compared to 8.9% of foreign-born women had a PTB (early PTB: aOR = 0.56, 95%, CI 0.38 to 0.82; late PTB: aOR = 0.57, 95%, CI 0.45 to 0.73; early term birth: aOR = 0.67, 95%, CI 0.58 to 0.77).

Conclusions: Foreign-born status remained protective of PTB, irrespective of severity and subtype. Preeclampsia, PTB, and GDM share pathophysiologic mechanisms suggesting a need to better understand differences in perinatal stress, chronic disease, and vascular dysfunction based on nativity in future epidemiologic studies and health services research.

Keywords: Anti-racist praxis; Black women; Gestational diabetes; Nativity; Preeclampsia; Preterm birth severity; Preterm birth subtypes.

MeSH terms

Adult
Black or African American / ethnology*
Black or African American / statistics & numerical data
California
Diabetes, Gestational / diagnosis*
Diabetes, Gestational / epidemiology
Diabetes, Gestational / ethnology
Emigrants and Immigrants / statistics & numerical data*
Female
Gestational Age
Health Status Disparities
Humans
Infant, Newborn
Maternal Age
Pre-Eclampsia / epidemiology*
Pregnancy
Premature Birth / epidemiology*
Premature Birth / ethnology
Prevalence
Protective Factors
Retrospective Studies
Risk Factors
Severity of Illness Index
Young Adult

Grants and funding

[K12 HD052163]/NICHD/ORWH