African-American women have higher initial HbA1c levels in diabetic pregnancy.
OBJECTIVE
African-American women with diabetes are at greater risk for poor glycemic control outside of pregnancy. We evaluated the effect of race on glycemic control in a racially mixed population of women with diabetes entering prenatal care.


METHODS
HbA1c levels along with demographic data were collected at the first prenatal visit from a group of 234 women with preexisting diabetes. We applied logistic multivariate analysis to identify factors associated with HbA1c levels above the median for the group.


RESULTS
The median HbA1c level for the group was 8%. HbA1c levels were 8.7 +/- 2.0% in African-Americans and 7.7 +/- 1.5% in Caucasians (P < 0.001). African-American racial designation was significantly and independently associated with high HbA1c when controlled for maternal age, parity, White classification, diabetes type, education, marital status, obesity, insurance type, and first trimester entry into care. The effect of race was confined to the nonobese patients, for whom the adjusted odds ratio for African-American race as a predictor of high HbA1c was 8.15 with a 95% CI of 2.41-27.58 (P = 0.001).


CONCLUSIONS
We found a clear racial disparity in glycemic control among women entering prenatal care with preexisting diabetes. This study demonstrates that there generally is need for better glycemic control among reproductive-age women with diabetes, but especially among those who are African-American.
Holcomb
W L
WL
Department of Obstetrics and Gynecology, St Louis University School of Medicine, Missouri 63117, USA. holcombw@slu.edu
Mostello
D J
DJ
Leguizamon
G F
GF
D000328:Adult; D044383:Black People; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000097:blood; D004522:Educational Status; D005260:Female; D005865:Gestational Age; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D017533:Marital Status; D008423:Maternal Age; D009765:Obesity; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*; D011295:Prenatal Care; D012016:Reference Values; D001741:Black or African American
D006442:Glycated Hemoglobin