Advertisement

Trends in gestational diabetes mellitus among nulliparous pregnant individuals with singleton live births in the United States between 2011 to 2019: an age-period-cohort analysis

Published:October 21, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100785

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Deputy NP
        • Kim SY
        • Conrey EJ
        • Bullard KM.
        Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth - United States, 2012-2016.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 1201-1207
        • Lavery JA
        • Friedman AM
        • Keyes KM
        • Wright JD
        • Ananth CV.
        Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010.
        BJOG. 2017; 124: 804-813
        • Gregory EC
        • Ely DM.
        Trends and characteristics in gestational diabetes: United States, 2016-2020.
        Natl Vital Stat Rep. 2022; 71: 1-15
        • Landon MB
        • Spong CY
        • Thom E
        • et al.
        A multicenter, randomized trial of treatment for mild gestational diabetes.
        N Engl J Med. 2009; 361: 1339-1348
        • Camelo Castillo W
        • Boggess K
        • Stürmer T
        • Brookhart MA
        • Benjamin DK
        • Jonsson Funk M
        Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
        JAMA Pediatr. 2015; 169: 452-458
        • Dennison RA
        • Chen ES
        • Green ME
        • et al.
        The absolute and relative risk of type 2 diabetes after gestational diabetes: a systematic review and meta-analysis of 129 studies.
        Diabetes Res Clin Pract. 2021; 171108625
        • Lowe WL
        • Scholtens DM
        • Kuang A
        • et al.
        Hyperglycemia and adverse pregnancy outcome follow-up study (HAPO FUS): maternal gestational diabetes mellitus and childhood glucose metabolism.
        Diabetes Care. 2019; 42: 372-380
        • Yu Y
        • Arah OA
        • Liew Z
        • et al.
        Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up.
        BMJ. 2019; 367: l6398
        • Shah NS
        • Wang MC
        • Freaney PM
        • et al.
        Trends in gestational diabetes at first live birth by race and ethnicity in the US, 2011-2019.
        JAMA. 2021; 326: 660-669
        • Venkatesh KK
        • Lynch CD
        • Powe CE
        • et al.
        Risk of adverse pregnancy outcomes among pregnant individuals with gestational diabetes by race and ethnicity in the United States, 2014-2020.
        JAMA. 2022; 327: 1356-1367
        • Carstensen B.
        Age-period-cohort models for the Lexis diagram.
        Stat Med. 2007; 26: 3018-3045
        • Holford TR.
        Analysing the temporal effects of age, period and cohort.
        Stat Methods Med Res. 1992; 1: 317-337
        • Clayton D
        • Schifflers E.
        Models for temporal variation in cancer rates. II: age-period-cohort models.
        Stat Med. 1987; 6: 469-481
        • Li Y
        • Ren X
        • He L
        • Li J
        • Zhang S
        • Chen W.
        Maternal age and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of over 120 million participants.
        Diabetes Res Clin Pract. 2020; 162108044
        • Study Cooperative Research Group HAPO
        • Metzger BE
        • Lowe LP
        • et al.
        Hyperglycemia and adverse pregnancy outcomes.
        N Engl J Med. 2008; 358: 1991-2002
        • Hillier TA
        • Pedula KL
        • Ogasawara KK
        • et al.
        A pragmatic, randomized clinical trial of gestational diabetes screening.
        N Engl J Med. 2021; 384: 895-904
        • Ananth CV
        • Keyes KM
        • Wapner RJ.
        Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis.
        BMJ. 2013; 347: f6564
        • Chu SY
        • Callaghan WM
        • Kim SY
        • et al.
        Maternal obesity and risk of gestational diabetes mellitus.
        Diabetes Care. 2007; 30: 2070-2076
        • Driscoll AK
        • Gregory ECW.
        Increases in prepregnancy obesity: United States, 2016-2019.
        NCHS Data Brief. 2020; : 1-8
      1. National Center for Vital Statistics. Guide to completing the facility worksheets for the certificate of live birth and report of fetal death. 2019. Available at:https://www.cdc.gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf. Accessed June 1, 2022.

        • Tutlam NT
        • Liu Y
        • Nelson EJ
        • Flick LH
        • Chang JJ.
        The effects of race and ethnicity on the risk of large-for-gestational-age newborns in women without gestational diabetes by prepregnancy body mass index categories.
        Matern Child Health J. 2017; 21: 1643-1654
        • Ingram DD
        • Parker JD
        • Schenker N
        • et al.
        United States Census 2000 population with bridged race categories.
        Vital Health Stat 2. 2003; 135: 1-55
        • Klein RJ
        • Proctor SE
        • Boudreault MA
        • Turczyn KM.
        Healthy People 2010 criteria for data suppression.
        Healthy People 2010 Stat Notes. 2002; (PMID: 12117004): 1-12
        • Rosenberg PS
        • Check DP
        • Anderson WF.
        A web tool for age-period-cohort analysis of cancer incidence and mortality rates.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 2296-2302
        • Mathews TJ
        • Hamilton BE.
        Mean age of mothers is on the rise: United States, 2000-2014.
        NCHS Data Brief. 2016; 232: 1-8
        • Bardenheier BH
        • Imperatore G
        • Gilboa SM
        • et al.
        Trends in gestational diabetes among hospital deliveries in 19 U.S. States, 2000-2010.
        Am J Prev Med. 2015; 49: 12-19
        • Coton SJ
        • Nazareth I
        • Petersen I.
        A cohort study of trends in the prevalence of pregestational diabetes in pregnancy recorded in UK general practice between 1995 and 2012.
        BMJ Open. 2016; 6e009494
        • Wang MC
        • Freaney PM
        • Perak AM
        • et al.
        Trends in prepregnancy obesity and association with adverse pregnancy outcomes in the United States, 2013 to 2018.
        J Am Heart Assoc. 2021; 10e020717
        • An R
        • Xiang X
        • Yang Y
        • Yan H.
        Mapping the prevalence of physical inactivity in U.S. States, 1984-2015.
        PLoS One. 2016; 11e0168175
        • Francis EC
        • Dabelea D
        • Shankar K
        • Perng W.
        Maternal diet quality during pregnancy is associated with biomarkers of metabolic risk among male offspring.
        Diabetologia. 2021; 64: 2478-2490
        • Wang MC
        • Shah NS
        • Petito LC
        • et al.
        Gestational diabetes and overweight/obesity: analysis of nulliparous women in the U.S., 2011-2019.
        Am J Prev Med. 2021; 61: 863-871
        • Catalano P
        • Shankar K.
        Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child.
        BMJ. 2017; 8: j1
        • Hill-Briggs F
        • Adler NE
        • Berkowitz SA
        • et al.
        Social determinants of health and diabetes: a scientific review.
        Diabetes Care. 2020; 44: 258-279
        • Chen L
        • Shi L
        • Zhang D
        • Chao SM.
        Influence of acculturation on risk for gestational diabetes among Asian women.
        Prev Chronic Dis. 2019; 16: E158
        • Vounzoulaki E
        • Khunti K
        • Abner SC
        • Tan BK
        • Davies MJ
        • Gillies CL.
        Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis.
        BMJ. 2020; 369: m1361
        • Tobias DK
        • Stuart JJ
        • Li S
        • et al.
        Association of history of gestational diabetes with long-term cardiovascular disease risk in a large prospective cohort of US women.
        JAMA Intern Med. 2017; 177: 1735-1742
        • Schwartz N
        • Nachum Z
        • Green MS.
        The prevalence of gestational diabetes mellitus recurrence–effect of ethnicity and parity: a metaanalysis.
        Am J Obstet Gynecol. 2015; 213: 310-317
        • Haghighat N
        • Hu M
        • Laurent O
        • Chung J
        • Nguyen P
        • Wu J.
        Comparison of birth certificates and hospital-based birth data on pregnancy complications in los Angeles and Orange County, California.
        BMC Pregnancy Childbirth. 2016; 16: 93
        • Devlin HM
        • Desai J
        • Walaszek A.
        Reviewing performance of birth certificate and hospital discharge data to identify births complicated by maternal diabetes.
        Matern Child Health J. 2009; 13: 660-666
        • Gregory ECW
        • Martin JA
        • Argov EL
        • Osterman MJK.
        Assessing the quality of medical and health data from the 2003 birth certificate revision: results from New York City.
        Natl Vital Stat Rep. 2019; 68: 1-20
        • Venkatesh KK
        • Chiang CW
        • Castillo WC
        • et al.
        Changing patterns in medication prescription for gestational diabetes during a time of guideline change in the USA: a cross-sectional study.
        BJOG. 2022; 129: 473-483