title: Race/ethnicity, educational attainment, and pregnancy complications in New York City women with pre-existing diabetes.
abstract: BACKGROUND
  More women are entering pregnancy with pre-existing diabetes. Disease severity, glycaemic control, and predictors of pregnancy complications may differ by race/ethnicity or educational attainment, leading to differences in adverse pregnancy outcomes.
  
  
  METHODS
  We used linked New York City hospital record and birth certificate data for 6291 singleton births among women with pre-existing diabetes between 1995 and 2003. We defined maternal race/ethnicity as non-Hispanic white, non-Hispanic black, Hispanic, South Asian, and East Asian, and education level as <12, 12, and >12 years. Our outcomes were pre-eclampsia, preterm birth (PTB) (<37 weeks gestation and categorised as spontaneous or medically indicated), as well as small-for-gestational age (SGA) and large-for-gestational age (LGA). Using multivariable binomial regression, we estimated the risk ratios for pre-eclampsia, SGA, and LGA. We used multivariable multinomial regression to estimate odds ratios (OR) for PTB.
  
  
  RESULTS
  Compared with non-Hispanic white women with pre-existing diabetes, non-Hispanic black and Hispanic women with pre-existing diabetes had a 1.50-fold increased risk of pre-eclampsia compared with non-Hispanic whites with pre-existing diabetes, after full adjustment. Non-Hispanic black and Hispanic women with pre-existing diabetes had adjusted ORs of 1.72 [adj. 95% confidence interval (CI) 1.38, 2.15] and 1.65 [adj.95% CI 1.32, 2.05], respectively, for medically indicated PTB. South Asian women with pre-existing diabetes had the highest risk for having an SGA infant [adj. OR: 2.29; adj. 95% CI 1.73, 3.03]. East Asian ethnicity was not associated with these pregnancy complications.
  
  
  CONCLUSIONS
  Non-Hispanic black, Hispanic, and South Asian women with pre-existing diabetes may benefit from targeted interventions to improve pregnancy outcomes.
authors.affiliation: Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Tamarra
authors.initials: T
authors.lastname: James-Todd
authors.forename: Teresa
authors.initials: T
authors.lastname: Janevic
authors.forename: Florence M
authors.initials: FM
authors.lastname: Brown
authors.forename: David A
authors.initials: DA
authors.lastname: Savitz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000208:ethnology; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D008423:Maternal Age; D009519:New York City / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000208:ethnology; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000453:epidemiology* / Q000208:ethnology; D047928:Premature Birth / Q000453:epidemiology / Q000208:ethnology; D011446:Prospective Studies; D044465:White People / Q000706:statistics & numerical data*
keywords: Hispanics; South Asians; education; large-for-gestational age; non-Hispanic blacks; pre-eclampsia; pre-existing diabetes; preterm birth; race; small-for-gestational age