TY - JOUR
T1 - Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years
AU - Hare, Matthew J.L.
AU - Barzi, Federica
AU - Boyle, Jacqueline A.
AU - Guthridge, Steven
AU - Dyck, Roland F.
AU - Barr, Elizabeth L.M.
AU - Singh, Gurmeet
AU - Falhammar, Henrik
AU - Webster, Vanya
AU - Shaw, Jonathan E.
AU - Maple-Brown, Louise J.
N1 - Funding Information:
MJLH undertook the analyses and wrote the manuscript. LJMB supervised all aspects of the study. FB, LJMB, SG and RFD conceived the project. FB led funding, ethics and data access applications. MJLH and FB designed and interpreted the analyses. JAB, SG, RFD, ELMB, GS, HF, JES and LJMB revised the analysis plan and assisted in interpreting the data. VW coordinated input from the Diabetes across the Lifecourse: Northern Australia Partnership Indigenous Reference Group and critically revised the manuscript from an Aboriginal perspective. All authors critically revised the manuscript for important intellectual content and approved the final manuscript. The authors would like to acknowledge the NT Government Department of Health as the data owner of the NT Perinatal Data Collection, Dr Shu Qin Li and Leanne O'Neil for provision of the data and maintaining the collection, and the many midwives who have entered data over many years. We also acknowledge the Diabetes across the Lifecourse: Northern Australia Partnership Indigenous Reference Group for their advice on this work. This project was supported by a Diabetes Australia Research Program General Grant. MJLH is supported by National Health and Medical Research Council (NHMRC) Postgraduate Scholarship #1169091, the NHMRC/Diabetes Australia Postgraduate Award and the Australian Academy of Science Douglas and Lola Douglas Scholarship in Medical Science. JES is supported by NHMRC Investigator Grant #1173952. JAB is supported by a NHMRC Career Development Fellowship. LMB is supported by NHMRC Practitioner Fellowship #1078477. Funding bodies had no role in the study design, analysis, interpretation, manuscript preparation or decision to submit the manuscript for publication. The Northern Territory Government Department of Health is the owner of the NT Perinatal Data Collection. Any access to the deidentified study dataset would require relevant approvals from the Department of Health and the support of the study investigators.
Funding Information:
The study was supported by a competitive grant from the Diabetes Australia Research Program. The funding body had no other input into the study. The corresponding author had full access to all data and final responsibility for the decision to submit for publication.
Funding Information:
MJLH, FB, SG, RFD, ELMB, GS, VW, JES and LJMB report a competitive grant from the Diabetes Australia Research Program for this study. MJLH also reports scholarship support from the National Health and Medical Research Council (NHMRC), Diabetes Australia and the Australian Academy of Science. JAB, JES and LJMB also report competitive fellowships or grants from the NHMRC. JES has received honoraria for lectures and consultancies unrelated to this study from AstraZeneca, Eli Lilly, Mylan, Novo Nordisk, Sanofi, Merck Sharp and Dohme, Abbott and Boehringer Ingelheim.
Publisher Copyright:
© 2020
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2020/8
Y1 - 2020/8
N2 - Background: Early-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia. Methods: We performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987-2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (<2500 g), and high birthweight (>4000 g). Logistic regression was used to assess trends and interactions. Findings: 109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3·4% and 0·6% in 1987 and rose to 13% and 5·7% in 2016 (both trends p<0·001). Among non-Aboriginal women, rates of GDM increased from 1·9% in 1987 to 11% in 2016 (p<0·001), while pre-existing diabetes was uncommon (≤0·7% throughout). Rates of small-for-gestational-age decreased, while rates of large-for-gestational-age and high birthweight increased in both groups (all trends p<0·001). Multivariable modelling suggests that hyperglycaemia was largely responsible for the growing rate of large-for-gestational-age births among Aboriginal women.Interpretation: The burden of hyperglycaemia in pregnancy has grown substantially in the NT over three decades and is impacting birthweight trends. The prevalence of pre-gestational diabetes in Aboriginal women is among the highest in the world.
AB - Background: Early-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia. Methods: We performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987-2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (<2500 g), and high birthweight (>4000 g). Logistic regression was used to assess trends and interactions. Findings: 109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3·4% and 0·6% in 1987 and rose to 13% and 5·7% in 2016 (both trends p<0·001). Among non-Aboriginal women, rates of GDM increased from 1·9% in 1987 to 11% in 2016 (p<0·001), while pre-existing diabetes was uncommon (≤0·7% throughout). Rates of small-for-gestational-age decreased, while rates of large-for-gestational-age and high birthweight increased in both groups (all trends p<0·001). Multivariable modelling suggests that hyperglycaemia was largely responsible for the growing rate of large-for-gestational-age births among Aboriginal women.Interpretation: The burden of hyperglycaemia in pregnancy has grown substantially in the NT over three decades and is impacting birthweight trends. The prevalence of pre-gestational diabetes in Aboriginal women is among the highest in the world.
UR - http://www.scopus.com/inward/record.url?scp=85103736676&partnerID=8YFLogxK
U2 - 10.1016/j.lanwpc.2020.100005
DO - 10.1016/j.lanwpc.2020.100005
M3 - Article
AN - SCOPUS:85103736676
VL - 1
SP - 1
EP - 10
JO - The Lancet Regional Health. Western Pacific
JF - The Lancet Regional Health. Western Pacific
SN - 2666-6065
M1 - 100005
ER -