Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis

Abstract

BackgroundIn addition to increasing the risk of adverse birth outcomes, diabetes in pregnancy is thought to be an important driver of the epidemic of type 2 diabetes affecting Canada’s First Nations population. The relative contributions of gestational diabetes mellitus (GDM) and pre-existing diabetes are not well understood. We generated a comprehensive epidemiological profile of diabetes in pregnancy over a 10-year period among the First Nations population of Alberta, Canada.MethodsDe-identified administrative data for 427,058 delivery records were obtained for the years 2000–2009. Pregnancy risk factors and delivery outcomes were described and compared by ethnicity (First Nations vs. non-First Nations) and diabetes status. Age-adjusted prevalence values for GDM and pre-existing diabetes were calculated and were compared by ethnicity. Longitudinal changes over time were also examined. Predictors were explored using logistic regression analysis.ResultsFirst Nations women had more antenatal risk factors and adverse infant outcomes that were compounded by diabetes. First Nations descent was an independent predictor of diabetes in pregnancy (p < 0.001). GDM prevalence was significantly higher among First Nations (6.1%) compared to non-First Nations women (3.8%; p < 0.001), but prevalence values increased significantly over time only in non-First Nations women (4.5 average annual percent change; p < 0.05). The prevalence of pre-existing diabetes was stable over time in both groups, but First Nations women experienced a 2.5-fold higher overall prevalence compared with non-First Nations women (1.5% vs. 0.6%, respectively; p < 0.001).ConclusionsAlthough First Nations women experience a higher overall prevalence of diabetes in pregnancy, the lack of increase in the prevalence over time is encouraging. However, because high-risk pregnancies and poor outcomes are more common among First Nations women, particularly those with diabetes, strategies to improve perinatal care must be implemented.

Occurrence of and referral to specialists for pain-related diagnoses in First Nations and non–First Nations children and youth

“…From as early as infancy, First Nations children experience substantial exposure to painful events. 35 The current study identified higher rates of NICU admissions among First Nations newborns compared with non-First Nations newborns, and additional research supports this finding. Oster and colleagues found that First Nations newborns were more likely to be admitted to the NICU for hypoglycemia related to maternal diabetes.…”

“…Oster and colleagues found that First Nations newborns were more likely to be admitted to the NICU for hypoglycemia related to maternal diabetes. 35 Research conducted in Canadian NICUs indicates newborns undergo an average of 11 painful procedures per day, 38 and infants with hypoglycemia require frequent blood sampling for glucose monitoring. 39 High rates of ear and dental condition diagnoses were evident in this study's First Nations cohort.…”

“…Admission to the NICU was a proxy measure for a pain event in early life because newborns admitted to the NICU experience many painful procedures meant to preserve their health and well-being. [32][33][34][35] An individual was identified as having a pain indicator by scanning all diagnostic variables in the DAD and billings data. International Classification of Diseases (ICD) codes (revisions 9 and 10) were used in both databases to distinguish the health conditions.…”

Solving the mystery: the true prevalence of gestational diabetes in indigenous women

“…Chamberlain et al . noted in one study where Australian indigenous women had a higher age‐adjusted GDM prevalence compared with non‐indigenous women at 6.3% versus 2.4% that was similar to results from a population‐based study conducted in Alberta, Canada, with reported rates of 6.1% versus 3.8%, respectively. In addition, Chamberlain et al .…”

Validation of administrative data case definitions for gestational diabetes mellitus

“…By contrast, the second algorithm based on the presence of gestational diabetes-specific ICD-9/10 codes during the delivery hospitalization, was associated with more acceptable sensitivity, specificity and positive predictive values of 86, 99 and 85%, respectively. Perhaps as a result of changing maternal characteristics, including older age and obesity, the rates of gestational diabetes are increasing [18,19]. Although gestational diabetes is generally a temporary condition and resolves postpartum, it is an established risk factor for the subsequent development of Type 2 diabetes [7,8].…”