Volume 124, Issue 5 p. 804-813
Maternal Medicine

Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010

JA Lavery

JA Lavery

Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

Biostatistics Coordinating Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

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AM Friedman

AM Friedman

Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

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KM Keyes

KM Keyes

Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA

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JD Wright

JD Wright

Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

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CV Ananth

Corresponding Author

CV Ananth

Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

Biostatistics Coordinating Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA

Correspondence: Dr CV Ananth, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY 10032, USA. Email [email protected]Search for more papers by this author
First published: 11 August 2016
Citations: 201

Linked article: This article is commented on by SK Abell, p. 814 in this issue. To view this mini commentary visit http://dx.doi.org/10.1111/1471-0528.14355.

This article includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights14236.

Abstract

Objective

To examine age–period–cohort effects on trends in gestational diabetes mellitus (GDM) prevalence in the US, and to evaluate how these trends have affected the rates of stillbirth and large for gestational age (LGA)/macrosomia.

Design

Retrospective cohort study.

Setting

USA, 1979–2010.

Population

Over 125 million pregnancies (3 337 284 GDM cases) associated with hospitalisations.

Methods

Trends in GDM prevalence were examined via weighted Poisson models to parse out the extent to which GDM trends can be attributed to maternal age, period of delivery, and maternal birth cohort. Multilevel models were used to assess the contribution of population effects to the rate of GDM. Log-linear Poisson regression models were used to estimate the contributions of the increasing GDM rates to changes in the rates of LGA and stillbirth between 1979–81 and 2008–10.

Main outcome measures

Rates and rate ratios (RRs).

Results

Compared with 1979–1980 (0.3%), the rate of GDM has increased to 5.8% in 2008–10, indicating a strong period effect. Substantial age and modest cohort effects were evident. The period effect is partly explained by period trends in body mass index (BMI), race, and maternal smoking. The increasing prevalence of GDM is associated with a 184% (95% CI 180–188%) decline in the rate of LGA/macrosomia and a 0.75% (95% CI 0.74–0.76) increase in the rate of stillbirths for 2008–10, compared with 1979–81.

Conclusions

The temporal increase in GDM can be attributed to period of pregnancy and age. Increasing BMI appears to partially contribute to the GDM increase in the US.

Tweetable abstract

The increasing prevalence of GDM can be attributed to period of delivery and increasing maternal age.