Obesity, Diabetes, and Birth Outcomes Among American Indians and Alaska Natives

Area of Science:

• Reproductive health
• Maternal-fetal medicine
• Health disparities

Background:

• Prepregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), and prepregnancy body mass index (BMI) are associated with adverse birth outcomes.
• Significant racial and ethnic disparities exist in diabetes and obesity rates in the US.

Purpose of the Study:

• To compare the associations of DM, GDM, and prepregnancy BMI with preterm delivery (PTB), low birthweight (LBW), and macrosomia.
• To specifically examine these relationships in American Indian and Alaska Native (AI/AN) populations compared to other race/ethnic groups.

Main Methods:

• Analysis of 5,193,386 singleton US first births from 2009-2013.
• Logistic regression models were used to calculate adjusted odds ratios.
• Covariates included calendar year, maternal age, education, marital status, prenatal care index, and child's sex.

Main Results:

• AI/AN populations exhibit higher rates of diabetes, overweight, and obesity compared to other groups.
• Prepregnancy overweight or obesity did not predict PTB for AI/AN, contrasting with other groups. Diabetes predicted increased PTB odds for all groups.
• Overweight was associated with reduced LBW odds for all groups, but obesity and diabetes were not predictive of LBW for AI/AN. DM, GDM, overweight, and obesity all predicted higher odds of macrosomia across all groups.

Conclusions:

• Diabetes in pregnancy and prepregnancy weight management are crucial for reducing PTB and macrosomia, particularly among AI/AN women.
• Understanding race/ethnic differences in the impact of metabolic and weight factors on birth outcomes is essential for targeted interventions.