Disparities in cardiometabolic risk profiles and gestational diabetes mellitus by nativity and acculturation: findings from 2016–2017 National Health Interview Survey

Abstract

IntroductionGestational diabetes mellitus (GDM) is a common complication of pregnancy with implications for cardiovascular health. Among reproductive-aged women, less is known about nativity-related disparities in cardiometabolic risk profiles and GDM history. We examined how cardiometabolic risk profiles and GDM history differed by nativity and explored associations between acculturation, cardiometabolic risk profiles and GDM history.Research design and methodsWe analyzed cross-sectional data from the 2016–2017 National Health Interview Survey among reproductive-aged women (18–49 years) who both reported ever being pregnant and answered the question on GDM history. Using multivariable logistic regression, we examined the percentage with GDM history and compared cardiometabolic profiles by nativity status and acculturation (duration of US residence).ResultsOf 9525 women, 22.5% were foreign-born. Also, 11.7% of foreign-born women had a GDM history vs 9.6% of US-born women. Foreign-born women with ≥10 years US residence had the highest age-standardized percentage with GDM history (11.0%) compared with US-born women (9.2%) and foreign-born women with <10 years US residence (6.7%). US-born women had a higher prevalence of hypertension, current smoking, and alcohol use than foreign-born women. Among foreign-born women, those with ≥10 years US residence had a higher prevalence of hypertension, current smoking, and alcohol use than those with <10 years US residence. In the fully adjusted model, foreign-born women with ≥10 years US residence had higher odds of GDM history than US-born women (OR 1.43; 95% CI 1.17 to 1.76) while foreign-born women with <10 years US residence and US-born women has similar odds of GDM history.ConclusionsGreater duration of US residence may be associated with nativity-related disparities in GDM. Acculturation, including changing health-related behaviors may explain the disparities among foreign-born women and should be further investigated to appropriately target interventions to prevent GDM and future cardiometabolic diseases.

Prevalence and Trends in Gestational Diabetes Mellitus Among Women in the United States, 2006–2017: A Population-Based Study

“…A major limitation is that self-reported physician-diagnosed GDM may under or overestimate the true prevalence of diagnosed GDM. However, the sensitivity and specificity of self-reported GDM have been reported in previous studies ( 16 ), and the self-reported GDM in NHIS has been widely used in other studies ( 45 , 46 ). Another potential limitation of this study is that information was limited on which criteria were used for the diagnosis of GDM.…”

Association between gestational diabetes and 6-year incident diabetes: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

“…Data from a cross-sectional US national survey found that foreign-born women with longer duration of US residence (≥10 years) had a greater odds of GDM history than US born women, suggesting that foreign-born women may acculturate and develop unhealthy behaviors that increase the risk of GDM. 23 In our study of HCHS/SOL participants, women who immigrated at age ≥30 years had a lower prevalence of GDM compared with those who immigrated as children (≤18 years); this may reflect underdiagnosis of GDM in a foreign country or underdiagnosis in earlier time periods before the importance of GDM on fetal and maternal health were established; it may also reflect acculturation in women who immigrated at a younger age. 24 We also found that the prevalence of self-reported GDM was higher for women with health insurance, which may reflect proper prenatal care and awareness, resulting in a lower likelihood that GDM goes undiagnosed.…”

“…While previous studies in the USA and Europe have found that foreign-born women have a higher prevalence of GDM,20–22 we found that the prevalence of self-reported GDM was similar for women born in the USA and women who immigrated and have lived in the USA for >15 years in our analysis of HCHS/SOL participants. Data from a cross-sectional US national survey found that foreign-born women with longer duration of US residence (≥10 years) had a greater odds of GDM history than US born women, suggesting that foreign-born women may acculturate and develop unhealthy behaviors that increase the risk of GDM 23. In our study of HCHS/SOL participants, women who immigrated at age ≥30 years had a lower prevalence of GDM compared with those who immigrated as children (≤18 years); this may reflect underdiagnosis of GDM in a foreign country or underdiagnosis in earlier time periods before the importance of GDM on fetal and maternal health were established; it may also reflect acculturation in women who immigrated at a younger age 24.…”

The role of acculturation in the process of advance care planning among Chinese immigrants: A narrative systematic review

“…55 Recent evidence shows that acculturation, mostly capturing immigrants' birthplace and the duration of their stay in the host country, is associated with their health-related behaviors and health outcomes. 56,57 Chinese immigrants' acculturation influences chronic condition management in a complex way, which is shaped by various factors, such as their cultural background, their goals for acculturation, and the pressure they feel to assimilate. 58 The difference in their behavior indicates how Chinese immigrants understand the difference between cultural and societal norms and the strategies they took to manage this challenge.…”