ABSTRACT
BACKGROUND
The rate of gestational diabetes mellitus has increased over the past decade. An age,
period, and cohort epidemiologic analysis can be used to understand how and why disease
trends have changed over time.
OBJECTIVE
This study aimed to estimate the associations of age (at delivery), period (delivery
year), and cohort (birth year) of the pregnant individual with trends in the incidence
of gestational diabetes mellitus in the United States.
STUDY DESIGN
We conducted an age, period, and cohort analysis of nulliparous pregnant adults aged
18 to 44 years with singleton live births from the National Vital Statistics System
from 2011 to 2019. Generalized linear mixed models were used to calculate the adjusted
rate ratios for the incidence of gestational diabetes mellitus for each 3-year maternal
age span, period, and cohort group compared with the reference group for each. We
repeated the analyses with stratification according to self-reported racial and ethnic
group (non-Hispanic Asian-Pacific Islander, non-Hispanic Black, Hispanic, and non-Hispanic
White) because of differences in the incidence of and risk factors for gestational
diabetes mellitus by race and ethnicity.
RESULTS
Among 11,897,766 pregnant individuals, 5.2% had gestational diabetes mellitus. The
incidence of gestational diabetes mellitus was higher with increasing 3-year maternal
age span, among those in the more recent delivery period, and among the younger birth
cohort. For example, individuals aged 42 to 44 years at delivery had a 5-fold higher
risk for gestational diabetes mellitus than those aged 18 to 20 years (adjusted rate
ratio, 5.57; 95% confidence interval, 5.43–5.72) after adjusting for cohort and period.
Individuals who delivered between 2017 and 2019 were at higher risk for gestational
diabetes mellitus than those who delivered between 2011 and 2013 (adjusted rate ratio,
1.24; 95% confidence interval, 1.23–1.25) after adjusting for age and cohort. Individuals
born between 1999 and 2001 had a 3-fold higher risk for gestational diabetes mellitus
than those born between 1969 and 1971 (adjusted rate ratio, 3.12; 95% confidence interval,
2.87–3.39) after adjusting for age and period. Similar age, period, and cohort effects
were observed for the assessed racial and ethnic groups, with the greatest period
effects observed among Asian and Pacific Islander individuals.
CONCLUSION
Period and birth cohort effects have contributed to the rising incidence of gestational
diabetes mellitus in the United States from 2011 to 2019.
Key words
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Article info
Publication history
Published online: October 21, 2022
Accepted:
October 18,
2022
Received:
October 11,
2022
Footnotes
The authors report no conflict of interest.
K.K.V. reports receiving support from the Care Innovation and Community Improvement Program at The Ohio State University and from the Agency for Healthcare Research and Quality under grant number R01HS028822. S.S.K. reports receiving funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health under grant number HL161514.
Cite this article as: Venkatesh KK, Harrington K, Cameron NA, et al. Trends in gestational diabetes mellitus among nulliparous pregnant individuals with singleton live births in the United States between 2011 and 2019: an age-period-cohort analysis. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
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