Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project

Objectives Because of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the two populations from 1980-2013. Methods Using Ministry of Health administrative databases, we examined overall GDM and pre-GDM predictors among a cohort of FN and non-FN women using logistic regression models. We compared early birth complications by ethnicity and DIP status using Chi square analysis. Results De-identified data was obtained for 69,176 FN and 344,410 non-FN pregnancies. Important GDM and pre-GDM predictors for FN and non-FN pregnancies were increasing maternal age; a previous high birth weight (HBW) or stillborn infant; and most importantly previous maternal GDM. Both GDM and pre-GDM were over 2.3 times as likely to occur among FN in multivariable analysis. FN and non-FN pregnancies with GDM and pre-GDM experienced higher rates of prematurity, shoulder dystocia, Caesarian section, HBW, and stillborn and infant death than those with no DIP. The largest rate disparities between FN and non-FN with DIP occurred with stillborn, HBW, and shoulder dystocia. Conclusions Along with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early maternal/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in pre-conception, prenatal and perinatal care are required to remove ethnicity-based disparities in DIP rates and outcomes.