title: Obesity, Diabetes, and Birth Outcomes Among American Indians and Alaska Natives.
abstract: Objectives To examine the relationships between prepregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), and prepregnancy body mass index, with several adverse birth outcomes: preterm delivery (PTB), low birthweight (LBW), and macrosomia, comparing American Indians and Alaska Natives (AI/AN) with other race/ethnic groups. Methods The sample includes 5,193,386 singleton US first births from 2009-2013. Logistic regression is used to calculate adjusted odds ratios controlling for calendar year, maternal age, education, marital status, Kotelchuck prenatal care index, and child's sex. Results AI/AN have higher rates of diabetes than all other groups, and higher rates of overweight and obesity than whites or Hispanics. Neither overweight nor obesity predict PTB for AI/AN, in contrast to other groups, while diabetes predicts increased odds of PTB for all groups. Being overweight predicts reduced odds of LBW for all groups, but obesity is not predictive of LBW for AI/AN. Diabetes status also does not predict LBW for AI/AN; for other groups, LBW is more likely for women with DM or GDM. Overweight, obesity, DM, and GDM all predict higher odds of macrosomia for all race/ethnic groups. Conclusions for Practice Controlling diabetes in pregnancy, as well as prepregnancy weight gain, may help decrease preterm birth and macrosomia among AI/AN.
authors.affiliation: Department of Anthropology, University of Oklahoma, 521 Dale Hall Tower, 455 West Lindsey, Norman, OK, 73019, USA. kganders@ou.edu.
authors.forename: Kermyt G
authors.initials: KG
authors.lastname: Anderson
authors.affiliation: Department of Anthropology, University of Oklahoma, 521 Dale Hall Tower, 455 West Lindsey, Norman, OK, 73019, USA.|Center for Applied Social Research, 201 Stephenson Parkway, Suite 4100, Norman, OK, 73019, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Spicer
authors.affiliation: Chickasaw Nation Department of Health, 1921 Stonecipher Blvd., Ada, OK, 74820, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Peercy
mesh_terms: D000328:Adult; D000072957:Alaska Natives; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000208:ethnology*; D005260:Female; D005320:Fetal Macrosomia / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D009765:Obesity / Q000208:ethnology*; D050177:Overweight; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000208:ethnology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D015430:Weight Gain; D055815:Young Adult
keywords: American Indians/Alaska Natives; Gestational diabetes; Low birthweight; Macrosomia; Obesity; Overweight; Preterm delivery