title: Gravidity, obesity, and non-insulin-dependent diabetes among Pima Indian women.
abstract: OBJECTIVE
  To evaluate the relationships among gravidity, obesity, and non-insulin-dependent diabetes mellitus in Pima Indian women.
  
  
  METHODS
  Pima Indian women (n = 2,779) participating in a longitudinal epidemiologic study of diabetes were evaluated in both cross-sectional and longitudinal analyses.
  
  
  RESULTS
  The prevalence of non-insulin-dependent diabetes was higher among women who had never been pregnant than among those who had been pregnant (age- and obesity-adjusted odds ratio = 2.0; 95% confidence interval = 1.5 to 2.7). Controlled for age and obesity, nondiabetic women who had never been pregnant had significantly higher fasting plasma glucose concentrations by 2% (P = 0.004), higher fasting serum insulin concentrations by 8% (P = 0.09), and higher 2-hour serum insulin concentrations by 10% (P = 0.07) than nondiabetic women who had been pregnant. Among 1,025 women observed for an average of 8 years, those who had not been pregnant by the baseline examination were at significantly higher risk for developing non-insulin-dependent diabetes before the age of 40 years (incidence rate ratio = 1.5; 95% confidence interval = 1.2 to 2.1), but that difference could be accounted for by a higher degree of obesity.
  
  
  CONCLUSIONS
  We hypothesize that Pima Indian women who have a high risk for non-insulin-dependent diabetes develop obesity and hyperinsulinemia at an early age, and that may be responsible for decreased fertility because of associated changes in sex hormones.
authors.affiliation: Department of Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona 85014.
authors.forename: M A
authors.initials: MA
authors.lastname: Charles
authors.forename: D J
authors.initials: DJ
authors.lastname: Pettitt
authors.forename: D R
authors.initials: DR
authors.lastname: McCance
authors.forename: R L
authors.initials: RL
authors.lastname: Hanson
authors.forename: P H
authors.initials: PH
authors.lastname: Bennett
authors.forename: W C
authors.initials: WC
authors.lastname: Knowler
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology*; D011247:Pregnancy / Q000208:ethnology*; D015995:Prevalence
chemical_list: D001786:Blood Glucose