Psychosocial, Behavioral, and Medical Drivers of Gestational Diabetes among Racial-Ethnic Groups

Certain racial and ethnic groups have historically been labeled "high-risk" for the development of gestational diabetes mellitus (GDM). Our objective was to identify the psychosocial, behavioral, and medical factors associated with GDM and determine if they differ by race/ethnicity.Secondary analysis of a multicenter, prospective cohort study of pregnant nulliparous individuals with singleton gestations (2010-2013). The primary outcome was GDM. Psychosocial, behavioral, and medical characteristics were compared by self-reported race/ethnicity. Multivariable logistic regression with backward selection identified factors associated with GDM. Interaction terms between race/ethnicity and risk factors were tested.Of 8,672 pregnant individuals, 61% were non-Hispanic White, 13% non-Hispanic Black, 17% Hispanic, 4% Asian, and 5% other. The incidence of GDM differed by race/ethnicity with 4% non-Hispanic White, 3% non-Hispanic Black, 5% Hispanic, 11% Asian, and 5% other (p < 0.001). Of 34 psychosocial, behavioral, and medical factors, those associated with GDM were parent with history of diabetes (adjusted odds ratio [aOR]: 1.72; 95% confidence interval [CI]: 1.33-2.23), non-English language (aOR: 2.57; 95% CI: 1.14-5.79), daily calorie intake (aOR: 1.18; 95% CI: 1.08-1.29), daily fiber intake (aOR: 0.84; 95% CI: 0.75-0.94), maternal age (aOR: 1.53; 95% CI: 1.37-1.70), prepregnancy BMI (aOR: 1.21; 95% CI: 1.02-1.44), and waist circumference (aOR: 1.21; 95% CI: 1.03-1.43). These associations did not differ based on race/ethnicity (interaction p-values > 0.1).Replacing race/ethnicity as a risk factor for GDM with significant upstream psychosocial, behavioral, and medical factors should be considered. · GDM varies in incidence based on race.. · GDM was linked to a parent with various factors.. · These factors are the history of diabetes, non-English language, and daily calorie intake.. · These factors also include lower daily fiber intake, maternal age, prepregnancy BMI, and waist circumference.. · The psychosocial, behavioral, and medical factors associated with GDM did not differ based on race/ethnicity..