Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years

Matthew John Hare, Federica Barzi, Jacqueline Boyle, Steven Guthridge, Roland Dyck, Elizabeth Barr, Gurmeet Singh, Henrik Falhammar, Vanya Webster, Jonathan E. Shaw, Louise Maple-Brown

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Abstract

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.
Original languageEnglish
Article number100005
Pages (from-to)1-10
Number of pages10
JournalThe Lancet Regional Health. Western Pacific
Volume1
Early online dateJul 2020
DOIs
Publication statusPublished - Aug 2020

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