Maternal race, procedures, and infant birth weight in type 2 and gestational diabetes.
OBJECTIVE
To examine the relation between race and cesarean delivery, episiotomy, and low birth weight infants in pregnancies with type 2 and gestational diabetes mellitus and to identify factors that might explain racial differences.


METHODS
Population-based, cross-sectional study of 1999-2004 Maryland hospital discharge data. Hospitalizations for delivery of pregnancies with type 2 and gestational diabetes mellitus were identified and matched to infants. The independent variable was maternal race. Dependent variables were cesarean delivery, episiotomy, and low infant birth weight. Stepwise logistic regression models were developed to estimate the independent effect of race on use of each procedure and infant birth weight, after adjusting for sociodemographic, hospital, and clinical factors.


RESULTS
We examined 6,310 deliveries for pregnancies with type 2 (15%) and gestational (85%) diabetes. Before adjustment, black race was associated with a higher odds of cesarean delivery (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.24-1.58) and low birth weight infants (OR 1.94, 95% CI 1.57-2.40) compared with white race. Adjustment for racial differences in preeclampsia and fetal heart rate abnormalities accounted for a modest degree of the racial variation in outcomes. With full adjustment, black race was still associated with a higher odds of cesarean delivery (OR 1.38, 95% CI 1.20-1.60) and low birth weight (OR 1.81, 95% CI 1.41-2.34) and a lower odds of episiotomy (OR 0.45, 95% CI 0.36-0.57).


CONCLUSIONS
In pregnancies with diabetes, adjustment for sociodemographic, hospital, and clinical factors only partially explains racial differences in procedure use and infant low birth weight.
Nicholson
Wanda K
WK
Department of Gynecology and Obstetrics, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA. wnichol@jhmi.edu
Fox
Harold E
HE
Cooper
Lisa A
LA
Strobino
Donna
D
Witter
Frank
F
Powe
Neil R
NR
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D016640:Diabetes, Gestational / Q000503:physiopathology*; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D044465:White People / Q000706:statistics & numerical data*