Racial/Ethnic and Nativity Disparities in Gestational Diabetes Mellitus, United States 2018-2021

Gestational diabetes mellitus (GDM) is associated with adverse pregnancy and birth complications. Asian populations have the highest risk of GDM, with even greater risk among foreign-born (FB) residents. Socio-political factors, such as heightened anti-Asian racism and travel restrictions during COVID19 may have further increased their risk of GDM. Our study sought to examine the associations between race/ethnicity, nativity status, and GDM rate and changes during COVID19.

We used the US National Center for Health Statistics natality administrative data (N = 14,219,719). We estimated GDM and birth rates by race/ethnicity (Asian non-Hispanic [NH], Native Hawaiian/Pacific Islander NH, American Indian and Alaska Native NH, Black NH, White NH, Multiracial NH, and Hispanic/Latina) and nativity status (US-born, Foreign-born). Race/ethnicity was evaluated as a social construct for racial discrimination and nativity was evaluated as a proxy for acculturation-related risk factors. We used multivariable robust Poisson regressions to estimate GDM rates per 100 live births for each racial/ethnic group pre-COVID19 (2018-2019) and during COVID19 (2021) by FB status, adjusting for socioeconomic and major pregnancy risk factors.

In adjusted models, both Asian NH and foreign-born persons had higher rates of GDM compared to White NH (rate ratio [RR]: 2.02, 95% confidence interval [CI]: 2.01, 2.04) and US-born (RR; 1.33, 95% CI: 1.32, 1.34) persons, respectively. Overall GDM rates increased significantly during COVID19 (RR: 1.18, 95% CI: 1.17, 1.18), with Asian US- and foreign-born persons experiencing the greatest absolute increase (US-born: +2.5, 95% CI: 2.4, 2.6; foreign-born: +3.6, 95% CI: 3.5, 3.6) compared to other racial/ethnic groups (US-born: range +1.3-1.7, foreign-born range: +0.5-2.9). Disaggregated by Asian ethnicity, Chinese and Vietnamese persons had the highest GDM rates overall and the greatest increase during COVID19.

We found significant disparities in GDM rates by race/ethnicity and nativity status between 2018 and 2021, with Asian and foreign-born persons having the highest rates of GDM. Investigation into potential socio-political and other contributing factors of reproductive health inequities during COVID19 may help explain these disparities.