Abstract
Objective: To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non-Indigenous women, compared with normoglycemia.
Methods: Data were from 1102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes
Outcomes in Remote Australia (PANDORA) Study. Age-adjusted associations of gestational diabetes mellitus (GDM) or pre-existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500 ml) were assessed using logistic regression. Multivariable-adjusted models included Indigenous ethnicity, diabetes type and their interaction.
Results: A higher proportion of Indigenous women developed PPH than non-Indigenous women (32% versus 22%; P < 0.001). Compared with non-Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were higher (odds ratio [OR] 1.83, 95% confidence intervals [CI] 1.11–3.02, and OR 1.72, 95% CI 0.99–3.00 after age adjustment, OR 1.84, 95% CI 1.06–3.19, and OR 1.33, 95% CI 0.70–2.54 after adjustment for school education and delivery mode, and OR 1.62, 95% CI 0.95–2.77, and OR 0.99, 95% CI 0.53–1.86 after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH.
Conclusion: The significantly higher rates of PPH experienced by Indigenous women compared with non-Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.
| Original language | English |
|---|---|
| Pages (from-to) | 296-304 |
| Number of pages | 9 |
| Journal | International Journal of Gynecology and Obstetrics |
| Volume | 155 |
| Issue number | 2 |
| Early online date | Jul 2021 |
| DOIs | |
| Publication status | Published - Nov 2021 |
Bibliographical note
Funding Information:This work was supported by the National Health and Medical Research Council of Australia (NHMRC Partnership Project Grant #1032116, NHMRC #1078333). The funder played no role in conducting the research or writing the paper. IML was not funded for this study; ELMB was supported by a National Heart Foundation post‐doctoral fellowship (#101291); ILL was supported by an Australian Postgraduate Award and Menzies scholarship; JAB was supported by NHMRC Career Development Fellowship; AB was supported by a Sylvia and Charles Viertel Senior Medical Research Fellowship and an NHMRC Senior Research Fellowship #1137563; JES was supported by NHMRC Investigator Grant #1173952; LMB was supported by NHMRC Practitioner Fellowship #1078477 and NHMRC Investigator Grant #1194698. The views expressed in this paper are those of the authors and do not reflect the views of the NHMRC.
Publisher Copyright:
© 2021 International Federation of Gynecology and Obstetrics
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
