Pregnancy and development of diabetes in First Nations and non‐First Nations women in Alberta, Canada

• Published in: Diabetic Medicine
• Main Authors: Mackenzie, M. L., Yuan, Y., Shen, Y., Toth, E. L., Bell, R. C., Oster, R. T.
• Other Authors: Natural Sciences and Engineering Research Council of Canada, Alberta Health Services, Alberta Innovates - Health Solutions
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2020
• Subjects: Canada; First Nations
• Online Access: http://dx.doi.org/10.1111/dme.14372; https://onlinelibrary.wiley.com/doi/pdf/10.1111/dme.14372; https://onlinelibrary.wiley.com/doi/full-xml/10.1111/dme.14372

Abstract Aim To conduct a retrospective population‐based study to examine the risk of developing diabetes after delivery in First Nations and non‐First Nations women in Alberta. Methods Delivery records (1999–2014) were linked to provincial administrative data, which allowed for a maximum follow‐up of 16 years after delivery. Prevalence of pregnancy risk factors were compared by First Nations status. Hazard ratios for diabetes after delivery by First Nations status, high pre‐pregnancy body weight (≥91 kg) and gestational diabetes status were estimated using the Cox proportional hazards model. Results Age‐adjusted prevalence of gestational diabetes (7.9% vs 4.6%; P <0.0001), high pre‐pregnancy body weight (18.8% vs 10.2%; P <0.0001) and diabetes after delivery (3.9% vs 1.1%; P <0.0001) were higher in First Nations women than in non‐First Nations women. Development of diabetes after delivery was higher with First Nations status (hazard ratio 3.0, 95% CI 2.6–3.4), high pre‐pregnancy body weight (hazard ratio 3.6, 95% CI 3.3–4.0) and gestational diabetes status (hazard ratio 19.2, 95% CI 17.9–20.6). The highest risk was within First Nations women with high pre‐pregnancy body weight and gestational diabetes (hazard ratio 54.8, 95% CI 45.2–66.5) compared to women without these three risk factors. Reduced prenatal visits per pregnancy (8.4 vs 10.7; P <0.0001) and delayed first prenatal visit (time to delivery 23.7 vs 26.7 weeks; P <0.0001) were observed in First Nations women compared to non‐First Nations women. Conclusion First Nations women are at greater risk of developing diabetes after pregnancy, with gestational diabetes being the strongest predictor. Strategies that target the specific needs of First Nations women before, during and after pregnancy are required.