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Obstetrics & Gynecology 2006;108:626-634
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Maternal Race, Procedures, and Infant Birth Weight in Type 2 and Gestational Diabetes

Wanda K. Nicholson, MD, MPH1,4, Harold E. Fox, MD1, Lisa A. Cooper, MD, MPH2,3,5,6, Donna Strobino, PhD4, Frank Witter, MD1 and Neil R. Powe, MD, MPH2,3,5,6

From the 1 Department of Gynecology and Obstetrics, Division of General Internal Medicine, 2 Department of Medicine, and the 3 Welch Center for Prevention, Epidemiology, and Clinical Research, the Johns Hopkins School of Medicine, Baltimore, Maryland; the Departments of 4 Population and Family Health Sciences, 5 Epidemiology, and 6 Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

OBJECTIVE: To examine the relation between race and cesarean delivery, episiotomy, and low birth weight infants in pregnancies with type 2 and gestational diabetes mellitus and to identify factors that might explain racial differences.

METHODS: Population-based, cross-sectional study of 1999–2004 Maryland hospital discharge data. Hospitalizations for delivery of pregnancies with type 2 and gestational diabetes mellitus were identified and matched to infants. The independent variable was maternal race. Dependent variables were cesarean delivery, episiotomy, and low infant birth weight. Stepwise logistic regression models were developed to estimate the independent effect of race on use of each procedure and infant birth weight, after adjusting for sociodemographic, hospital, and clinical factors.

RESULTS: We examined 6,310 deliveries for pregnancies with type 2 (15%) and gestational (85%) diabetes. Before adjustment, black race was associated with a higher odds of cesarean delivery (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.24–1.58) and low birth weight infants (OR 1.94, 95% CI 1.57–2.40) compared with white race. Adjustment for racial differences in preeclampsia and fetal heart rate abnormalities accounted for a modest degree of the racial variation in outcomes. With full adjustment, black race was still associated with a higher odds of cesarean delivery (OR 1.38, 95% CI 1.20–1.60) and low birth weight (OR 1.81, 95% CI 1.41–2.34) and a lower odds of episiotomy (OR 0.45, 95% CI 0.36–0.57).

CONCLUSION: In pregnancies with diabetes, adjustment for sociodemographic, hospital, and clinical factors only partially explains racial differences in procedure use and infant low birth weight.

LEVEL OF EVIDENCE: II-2






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