The association between diabetes mellitus among American Indian/Alaska Native populations with preterm birth in eight U.S. states from 2004-2011 Público

Abstract

Background: American Indians and Alaska Natives (AI/AN) have the highest prevalence of diabetes mellitus (DM) in the United States. Previous research has indicated that women with prepregnancy DM or gestational DM are at increased risk for poor perinatal outcomes, such as preterm birth (PTB). Disparities in preterm birth between racial/ethnic groups are well documented; however, data on the association of maternal risk factors and poor perinatal outcomes within AI/AN women is limited.

Methods: We utilized surveillance data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS) to assess whether DM is associated with PTB among AI/AN women in Alaska, Minnesota, Nebraska, New Mexico, Oklahoma, Oregon, Utah and Washington from 2004-2011. We further examined whether this association differed between states.Using a population-based retrospective cohort of 12,420 live singleton births to AI/AN women we conducted backwards elimination and forward selection to construct a multivariable logistic regression model that estimates the odds of preterm birth among women with DM compared to women without DM.

Results: Women with DM had 1.83 (95% CI: 1.21-2.78, p = 0.004) times the odds of having a preterm birth than women without DM after controlling for maternal age and prepregnancy BMI. After stratifying on state, women with DM in Nebraska had the greatest odds of preterm birth (aOR = 6.63, p = 0.00) while AI/AN women in Alaska had a protective effect of DM (aOR = 0.17, p = 0.00).

Discussion: This finding suggests a misreporting or lack of adequate diagnosis of DM and GDM in Alaska. Our results indicate a significant association of DM with preterm birth in AI/AN women. Differences across states call for increased surveillance, assessment of health data quality, and public health efforts in high-risk areas. Further research is needed to compare these results to other minority populations and to assess whether differences across states can be attributed to tribal, healthcare or lifestyle factors.

Table of Contents

Table of Contents

Introduction………………………………………..……………..1 Background…………………………………………………………3 Methods………………………………………………………….…27 Manuscript……………………………………………………...…35 Results……………………………………………………………...53 Discussion………………………………………………………….59 Conclusion……………………………………………………….…65 References……………………………………………………..….66 Tables……………………………………………………………..…83

Figures………………………………………………………….….104

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Native American Studies Health Sciences, Public Health Health Sciences, Epidemiology
Palavra-chave	prepregnancy diabetes perinatal outcomes pregnancy gestational diabetes American Indian preterm birth metabolic disorders Alaska Native diabetes mellitus chronic disease pregnancy risk factors
Committee Chair / Thesis Advisor	Hogue, Carol J, Emory University
Partnering Agencies	State or local health department (not in Georgia) Emory University schools, faculty or affiliated programs CDC

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