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

Venkatesh, Kartik K.; Harrington, Katharine; Cameron, Natalie A; Petito, Lucia; Powe, Camille E.; Landon, Mark B.; Grobman, William A.; Khan, Sadiya S.

doi:10.1016/j.ajogmf.2022.100785

Cited by 10 publications

(13 citation statements)

References 34 publications

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“…In a recent age, period, and cohort epidemiological analysis, the incidence of GDM was demonstrated to be higher among those who delivered in more recent years and among younger birth cohorts with a 3-fold higher risk for GDM among pregnant individuals who were themselves born between 1999 and 2001 compared with those born between 1969 and 1971. 65 GDM is associated with significant short-and longterm adverse maternal and offspring outcomes. 66 From 2014 to 2020, the frequency of maternal and neonatal complications increased among pregnant individuals in the United States with GDM.…”

Section: Hdps: Gestational Hypertension and Preeclampsiamentioning

confidence: 99%

Section: Apos Cvd Risk Factors and Cvd Riskmentioning

confidence: 99%

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Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

Khan

Cameron

Lindley

2023

Circulation Research

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Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.

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Section: Hdps: Gestational Hypertension and Preeclampsiamentioning

confidence: 99%

Section: Apos Cvd Risk Factors and Cvd Riskmentioning

confidence: 99%

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

Khan

Cameron

Lindley

2023

Circulation Research

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“…In 2020, DM and GDM occurred in 1% and 8% of all pregnant women, 2 respectively. For GDM, this frequency has increased 30% since 2016 3,4 . Reasons for the increasing frequency of diabetes in pregnancy have been attributed to multiple factors, including increases in older maternal age, 5 obesity, 6 and adverse lifestyle factors, such as worse diet and less physical activity 7,8 .…”

Section: Introductionmentioning

confidence: 99%

“…For GDM, this frequency has increased 30% since 2016. 3,4 Reasons for the increasing frequency of diabetes in pregnancy have been attributed to multiple factors, including increases in older maternal age, 5 obesity, 6 and adverse lifestyle factors, such as worse diet and less physical activity. 7,8 Diabetes during pregnancy increases the risk of severe maternal morbidity and mortality, 9 and adverse maternal and infant health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Rural–urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross‐sectional analysis of over 12 million pregnancies

Venkatesh

Huang

Cameron

et al. 2023

BJOG

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ObjectiveTo compare trends in pregestational (DM) and gestational diabetes (GDM) in pregnancy in rural and urban areas in the USA, because pregnant women living in rural areas face unique challenges that contribute to rural–urban disparities in adverse pregnancy outcomes.DesignSerial, cross‐sectional analysis.SettingUS National Center for Health Statistics (NCHS) Natality Files from 2011 to 2019.PopulationA total of 12 401 888 singleton live births to nulliparous women aged 15–44 years.MethodsWe calculated the frequency (95% confidence interval [CI]) per 1000 live births, the mean annual percentage change (APC), and unadjusted and age‐adjusted rate ratios (aRR) of DM and GDM in rural compared with urban maternal residence (reference) per the NCHS Urban–Rural Classification Scheme overall, and by delivery year, reported race and ethnicity, and US region (effect measure modification).Main outcome measuresThe outcomes (modelled separately) were diagnoses of DM and GDM.ResultsFrom 2011 to 2019, there were increases in both the frequency (per 1000 live births; mean APC, 95% CI per year) of DM and GDM in rural areas (DM: 7.6 to 10.4 per 1000 live births; APC 2.8%, 95% CI 2.2%–3.4%; and GDM: 41.4 to 58.7 per 1000 live births; APC 3.1%, 95% CI 2.6%–3.6%) and urban areas (DM: 6.1 to 8.4 per 1000 live births; APC 3.3%, 95% CI 2.2%–4.4%; and GDM: 40.8 to 61.2 per 1000 live births; APC 3.9%, 95% CI 3.3%–4.6%). Individuals living in rural areas were at higher risk of DM (aRR 1.48, 95% CI 1.45%–1.51%) and GDM versus those in urban areas (aRR 1.17, 95% CI 1.16%–1.18%). The increased risk was similar each year for DM (interaction p = 0.8), but widened over time for GDM (interaction p < 0.01). The rural–urban disparity for DM was wider for individuals who identified as Hispanic race/ethnicity and in the South and West (interaction p < 0.01 for all); and for GDM the rural–urban disparity was generally wider for similar factors (i.e. Hispanic race/ethnicity, and in the South; interaction p < 0.05 for all).ConclusionsThe frequency of DM and GDM increased in both rural and urban areas of the USA from 2011 to 2019 among nulliparous pregnant women. Significant rural–urban disparities existed for DM and GDM, and increased over time for GDM. These rural–urban disparities were generally worse among those of Hispanic race/ethnicity and in women who lived in the South. These findings have implications for delivering equitable diabetes care in pregnancy in rural US communities.

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“…Gestational diabetes mellitus (GDM) affects nearly 400,000 or at least 1 in 10 pregnant individuals in the United States every year. 1,2 GDM increases the likelihood of adverse pregnancy outcomes (APOs), such as large-for-gestational age birth, neonatal intensive care unit (NICU) admission, and cesarean delivery, and long-term cardiometabolic disease after delivery for the mother and infant, [3][4][5] both of which are persistently disparate by maternal race and ethnicity. 6 Treatment of GDM to achieve glycemic control (generally defined as >50-70% of fasting glucose values <95 mg/dL and/or postprandial values <120 mg/dL 2 hours or <140 mg/dL 1 hour after a meal) decreases the risk of APOs.…”

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confidence: 99%

Patient Priorities, Decisional Comfort, and Satisfaction with Metformin versus Insulin for the Treatment of Gestational Diabetes Mellitus

Venkatesh,

Wu,

Trinh

et al. 2023

Am J Perinatol

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Objective We compared patient priorities, decisional comfort, and satisfaction with treating gestational diabetes mellitus (GDM) with metformin versus insulin among pregnant individuals with GDM requiring pharmacotherapy. Study Design We conducted a cross-sectional study of patients' perspectives about GDM pharmacotherapy in an integrated prenatal and diabetes care program from October 19, 2022, to August 24, 2023. The exposure was metformin versus insulin as the initial medication decision. Outcomes included standardized measures of patient priorities, decisional comfort, and satisfaction about their medication decision. Results Among 144 assessed individuals, 60.4% were prescribed metformin and 39.6% were prescribed insulin. Minoritized individuals were more likely to receive metformin compared with non-Hispanic White individuals (34.9 vs. 17.5%; p = 0.03). Individuals who were willing to participate in a GDM pharmacotherapy clinical trial were more likely to receive insulin than those who were unwilling (30.4 vs. 19.5%; p = 0.02). Individuals receiving metformin were more likely to report prioritizing avoiding injections (62.4 vs. 19.3%; adjusted odds ratio [aOR]: 2.83; 95% confidence interval [CI]: 1.10–7.31), wanting to take a medication no more than twice daily (56.0 vs. 30.4%; aOR: 3.67; 95% CI: 1.56–8.67), and believing that both medications can equally prevent adverse pregnancy outcomes (70.9 vs. 52.6%; aOR: 2.67; 95% CI: 1.19–6.03). Conversely, they were less likely to report prioritizing a medication that crosses the placenta (39.1 vs. 82.5%; aOR: 0.09; 95% CI: 0.03–0.25) and needing supplemental insulin to achieve glycemic control (21.2 vs. 47.4%; aOR: 0.36; 95% CI: 0.15–0.90). Individuals reported similarly high (mean score > 80%) levels of decisional comfort, personal satisfaction with medication decision-making, and satisfaction about their conversation with their provider about their medication decision with metformin and insulin (p ≥ 0.05 for all). Conclusion Individuals with GDM requiring pharmacotherapy reported high levels of decision comfort and satisfaction with both metformin and insulin, although they expressed different priorities in medication decision-making. These results can inform future patient-centered GDM treatment strategies. Key Points:

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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

Cited by 10 publications

References 34 publications

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

Rural–urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross‐sectional analysis of over 12 million pregnancies

Patient Priorities, Decisional Comfort, and Satisfaction with Metformin versus Insulin for the Treatment of Gestational Diabetes Mellitus

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