Estimating the Recurrence Rate of Gestational Diabetes Mellitus (GDM) in Massachusetts 1998–2007: Methods and Findings

• Published in: Maternal and child health journal Vol. 19; no. 10; pp. 2303 - 2313
• Main Authors: England, Lucinda, Kotelchuck, Milton, Wilson, Hoyt G., Diop, Hafsatou, Oppedisano, Paul, Kim, Shin Y., Cui, Xiaohui, Shapiro-Mendoza, Carrie K.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2015; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Agreements; Birth certificates; Births; Body Mass Index; Classification; Cohort Studies; Complications and side effects; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - mortality; Diabetes, Gestational - epidemiology; Diabetes, Gestational - mortality; Diagnosis; Female; Gestational diabetes; Gynecology; Health aspects; Humans; Hyperglycemia; Lifestyles; Longitudinal Studies; Massachusetts - epidemiology; Maternal and Child Health; Medicine; Medicine & Public Health; Middle Aged; Parity; Pediatrics; Population characteristics; Population Economics; Pregnancy; Prevalence; Public Health; Recurrence; Risk factors; Sociology; Type 2 diabetes; Massachusetts; United States > US; Pregnancy; Gestational diabetes mellitus; Diabetes; Diabetes recurrence; Sequential pregnancies
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-015-1750-x

Objectives Women with gestational diabetes mellitus (GDM) may be able to reduce their risk of recurrent GDM and progression to type 2 diabetes mellitus through lifestyle change; however, there is limited population-based information on GDM recurrence rates. Methods We used data from a population of women delivering two sequential live singleton infants in Massachusetts (1998–2007) to estimate the prevalence of chronic diabetes mellitus (CDM) and GDM in parity one pregnancies and recurrence of GDM and progression from GDM to CDM in parity two pregnancies. We examined four diabetes classification approaches; birth certificate (BC) data alone, hospital discharge (HD) data alone, both sources hierarchically combined with a diagnosis of CDM from either source taking priority over a diagnosis of GDM, and both sources combined including only pregnancies with full agreement in diagnosis. Descriptive statistics were used to describe population characteristics, prevalence of CDM and GDM, and recurrence of diabetes in successive pregnancies. Diabetes classification agreement was assessed using the Kappa statistic. Associated maternal characteristics were examined through adjusted model-based t tests and Chi square tests. Results A total of 134,670 women with two sequential deliveries of parities one and two were identified. While there was only slight agreement on GDM classification across HD and BC records, estimates of GDM recurrence were fairly consistent; nearly half of women with GDM in their parity one pregnancy developed GDM in their subsequent pregnancy. While estimates of progression from GDM to CDM across sequential pregnancies were more variable, all approaches yielded estimates of ≤5 %. The development of either GDM or CDM following a parity one pregnancy with no diagnosis of diabetes was <3 % across approaches. Women with recurrent GDM were disproportionately older and foreign born. Conclusion Recurrent GDM is a serious life course public health issue; the inter-pregnancy interval provides an important window for diabetes prevention.