title: The Association Between Diabetes Mellitus Among American Indian/Alaska Native Populations with Preterm Birth in Eight US States from 2004-2011.
abstract: OBJECTIVE
  Assess risk of preterm birth associated with diabetes mellitus (DM) among American Indian and Alaska Natives (AI/AN), a population with increased risk of DM and preterm birth, and examine whether this association differed by state of residence.
  
  
  METHODS
  We used surveillance data from the Pregnancy Risk Assessment Monitoring System from 12,400 AI/AN respondents with singleton births in Alaska, Minnesota, Nebraska, New Mexico, Oklahoma, Oregon, Utah, and Washington from 2004-2011. We conducted multivariable logistic regression models to estimate the odds ratio adjusted for maternal age and prepregnancy BMI with all observations and then stratified by state.
  
  
  RESULTS
  DM was reported in 5.92 % of the study population and preterm birth occurred in 8.95 % of births. Women with DM had 1.92 times higher odds of having a preterm birth than women without DM [95 % confidence interval (CI) 1.21-2.78]. After stratifying on state, women with DM in Nebraska had the greatest odds of preterm birth [aOR 6.63, (95 % CI 3.80-11.6)] while women in Alaska saw a protective effect from DM [aOR 0.17, (95 % CI 0.07-0.42)] compared to women without DM.
  
  
  CONCLUSIONS
  Overall, AI/AN women with DM had significantly greater odds of preterm birth compared to AI/AN women without DM across states. Substantial differences in this association between states calls for increased public health efforts in high-risk areas as well as further research to assess whether differences are attributable to diagnosis, reporting, tribal, healthcare or lifestyle factors.
authors.affiliation: Emory University, 1518 Clifton Road NE, Atlanta, GA, 30324, USA. haley.dorfman@gmail.com.
authors.forename: Haley
authors.initials: H
authors.lastname: Dorfman
authors.affiliation: Emory University, 1518 Clifton Road NE, Atlanta, GA, 30324, USA. meghna022@gmail.com.
authors.forename: Meghna
authors.initials: M
authors.lastname: Srinath
authors.affiliation: Emory University, 1518 Clifton Road NE, Atlanta, GA, 30324, USA. kari.rockhill@gmail.com.
authors.forename: Karilynn
authors.initials: K
authors.lastname: Rockhill
authors.affiliation: Emory University, 1518 Clifton Road NE, Atlanta, GA, 30324, USA. carol.hogue@emory.edu.
authors.forename: Carol
authors.initials: C
authors.lastname: Hogue
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000413:Alaska; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D007231:Infant, Newborn; D007234:Infant, Premature; D004930:Inuit / Q000208:ethnology*; D016015:Logistic Models; D015999:Multivariate Analysis; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000208:ethnology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000208:ethnology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: American Indian/Alaska Native; Diabetes mellitus; PRAMS; Pregnancy; Preterm birth