The Association of Immigrant Status, Preeclampsia, and Gestational Age at Delivery among Black Women with Diabetes in California Pubblico

Abstract

Purpose: Black women are at higher risk for pregestational diabetes (PGDM), gestational diabetes (GDM), and preterm birth (PTB, < 37 completed weeks’ gestation). Foreign-born women have lower risk of PTB. We examined associations between immigrant status, maternal, social, and obstetric characteristics, and risk of PTB among Black women with any diabetes.

Methods: From 3,160,268 California live births, 2007-2012, we assessed 7,024 singleton PTBs or full term births (39-40 weeks) from non-Hispanic Black (NHB) diabetic women. We examined crude (cOR) and adjusted odds ratios (aOR) with stepwise backward logistic regression and 95% confidence intervals (CIs).

Results: Foreign-born status was associated with a lower risk of PTB [OR 0.51 (95% CI 0.43, 0.61)]. U.S.-born women, compared to Foreign-born women, were more likely to have some characteristics associated with PTB (< 25 years of age, < 12 years of education, Medicaid-paid delivery, uterine tract infection (UTI), smoking, preeclampsia, and obesity (BMI >30). The greatest cORs for PTB were for preeclampsia [7.52(6.41, 8.83)], smoking [1.67(1.42, 1.96)], and obesity [1.22(1.05, 1.40)]. After adjustment, aOR for PTB among Foreign-born births was 0.56(0.44, 0.71).

Conclusions: Foreign-born status is protective of PTB among NHB diabetic women. Further research is needed on preeclampsia, smoking, obesity, and structural racism.

Table of Contents

CHAPTER 1……………………………………………………………………………...1

CHAPTER 2……………………………………………………………………………...4

           Introduction…………………………………………………………………..........4

           Materials and Methods…………………………………………………………….6

           Results……………………………………………………………………………..9

           Discussion……………………………………………………………………......16

CHAPTER 3…………………………………………………………………………….20

REFERENCES………………………………………………………………………….32

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Obstetrics and Gynecology
Parola chiave	diabetes Black women preeclampsia preterm birth immigrant status
Committee Chair / Thesis Advisor	Hogue, Carol J., Emory University
Committee Members	Chambers, Brittany D., University of California, San Francisco McLemore, Monica R., University of California, San Francisco Jelliffe-Pawlowski, Laura L., University of California, San Francisco
Partnering Agencies	University, college or education institution (other than Emory)

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