Department of Medicine/Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA.
Diabetologia. 2012 Apr;55(4):971-80. doi: 10.1007/s00125-011-2430-z. Epub 2012 Jan 12.
AIMS/HYPOTHESIS: To determine the impact of maternal diabetes during pregnancy on racial disparities in fetal growth.
Using linked birth certificate, inpatient hospital and prenatal claims data we examined live singleton births of mothers resident in South Carolina who self-reported their race as non-Hispanic white (NHW; n = 140,128) or non-Hispanic black (NHB; n = 82,492) and delivered at 28-42 weeks' gestation between 2004 and 2008.
Prepregnancy diabetes prevalence was higher in NHB (3.0%) than in NHW (1.7%), while the prevalence of gestational diabetes mellitus (GDM) was similar in NHB (6.1%) and NHW (6.3%). At a delivery BMI of 35 kg/m(2), GDM exposure was associated with an average birthweight only 17 g (95% CI 4, 30) higher in NHW, but 78 g (95% CI 61, 95) higher in NHB (controlling for gestational age, maternal age, infant sex and availability of information on prenatal care). Figures for prepregnancy diabetes were 58 g (95% CI 34, 81) in NHW and 60 g (95% CI 37, 84) in NHB. GDM had a greater impact on birthweight in NHB than in NHW (60 g racial difference [95% CI 39, 82]), while prepregnancy diabetes had a large but similar impact. Similarly, the RR for GDM of having a large- relative to a normal-weight-for-gestational-age infant was lower in NHW (RR 1.41 [95% CI 1.34, 1.49]) than in NHB (RR 2.24 [95% CI 2.05, 2.46]).
CONCLUSIONS/INTERPRETATION: These data suggest that the negative effects of GDM combined with obesity during pregnancy may be greater in NHB than in NHW individuals.
目的/假设：确定母亲在怀孕期间患糖尿病对胎儿生长的种族差异的影响。
我们使用链接的出生证明、住院病历和产前索赔数据，检查了居住在南卡罗来纳州的母亲所生的单胎活产儿，这些母亲自报种族为非西班牙裔白人（NHW；n=140128）或非西班牙裔黑人（NHB；n=82492），并在 2004 年至 2008 年间在 28-42 周龄时分娩。
NHB（3.0%）的孕前糖尿病患病率高于 NHW（1.7%），而 NHB（6.1%）和 NHW（6.3%）的妊娠期糖尿病（GDM）患病率相似。在分娩 BMI 为 35kg/m2 时，GDM 暴露仅使 NHW 的平均出生体重增加 17g（95%CI 4，30），而使 NHB 的平均出生体重增加 78g（95%CI 61，95）（控制孕龄、产妇年龄、婴儿性别和产前保健信息的可用性）。孕前糖尿病的数字分别为 NHW 58g（95%CI 34，81）和 NHB 60g（95%CI 37，84）。GDM 对 NHB 出生体重的影响大于 NHW（60g 种族差异[95%CI 39，82]），而孕前糖尿病的影响较大但相似。同样，GDM 使巨大儿相对于正常胎龄儿的相对风险（RR）在 NHW 中较低（RR 1.41[95%CI 1.34，1.49]），而在 NHB 中较高（RR 2.24[95%CI 2.05，2.46]）。
结论/解释：这些数据表明，怀孕期间 GDM 合并肥胖的负面影响在 NHB 中可能大于 NHW 个体。
