Race in US obstetric clinical trials: An analysis of reporting and representation from 2007-2020

Abstract

OBJECTIVE:To assess maternal and neonatal outcomes between women with GDM who receive WIC benefits compared to those who don't. STUDY DESIGN: e performed a retrospective cohort study using National Vital Statistics Birth Data of births to women between 2014-2018. Inclusion criteria were women who were diagnosed with gestational diabetes (GDM) during their pregnancy. We analyzed maternal and neonatal outcomes for these women who received WIC benefits compared to those who did not receive WIC benefits. Bivariate tests and multivariable logistic regression were used for comparison. Maternal race/ethnicity, body mass index, age, parity, chronic hypertension, educational attainment, insurance type, and cigarette use were included as confounders. All analyses were conducted using STATA version 17. RESULTS: There were 1,088,949 deliveries to women with GDM included in the analysis; 41% receiving WIC and 59% who did not receive WIC. Women with GDM receiving WIC compared to control were less likely to be obese (46.82% vs 53.2%); however, more likely to be enrolled in Medicaid (72.7% vs 27.3%), and to be an active smoker (61.7% vs 38.3%). Receipt of WIC benefits in women with GDM was associated with higher odds of cesarean delivery (aOR 1.017, 95% CI 1.005-1.029 and higher odds of neonatal LGA (aOR 1.100, 95% CI 1.082-1.112). There was no difference in maternal gestational hypertension/preeclampsia, eclampsia, maternal ICU admission, neonatal ICU admission, small for gestational age, or neonatal ventilation requirements. CONCLUSION: Receipt of WIC resulted in varied outcomes among women with GDM suggesting that the role of WIC and nutrition in perinatal health outcomes is complicated. Therefore, further studies are needed to determine the role of nutrition and nutritional access and pregnancy outcomes. Although nutrition is imperative for management of GDM, the importance of exercise and medication therapy in addition to nutritional health cannot be assessed with this study and should be further researched.