Date of Award

Fall 12-18-2013

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Ike Okosun

Second Advisor

Dr. Kim Ramsey-White

Third Advisor

None

Fourth Advisor

None

Fifth Advisor

None

Sixth Advisor

None

Seventh Advisor

None

Abstract

ABSTRACT

Background: Evidence suggests that gestational diabetes mellitus (GDM) is associated with various metabolic conditions including elevated cholesterol, low HDL, elevated LDL, elevated triglycerides and obesity. However, comparative data on the association between GDM and various metabolic conditions across racial/ethnic groups are rare. This study focuses on differences in metabolic profiles among pregnant Non-Hispanic (NH) Whites, NH-Blacks, Mexican-Americans and women of other races/ethnicities with prediabetes and diabetes.

Method: Available data from the 1999 to 2010 survey waves of the National Health and Nutrition Examination Survey (NHANES) was used for this study. NHANES uses a stratified multistage probability sample of the civilian non-institutionalized population of the US chosen from a broad range of age groups and racial/ethnic backgrounds. Descriptive statistics were used to describe demographic variables, metabolic profiles across prediabetes/diabetes status. Univariate and multivariate logistic regression analyses were then used to determine the association between metabolic variables and prediabetes/diabetes across race/ethnicity.

Results: The study population (n=1417) consisted NH-Whites (N=620), NH-Blacks (N=219), Mexican-Americans (N=420), and “Other” races (N=168). Individuals with high LDL levels were significantly more likely to be diagnosed with GDM when compared to those with low LDL in both the crude (OR= 3.47, 95% CI= 1.90-6.33) and adjusted (OR= 2.81, 95% CI= 1.17-6.75) models. Individuals with high triglycerides levels were significantly more likely to be diagnosed with GDM when compared with individuals with low triglycerides in both the crude (OR= 2.44,95% CI= 1.36-4.38), and adjusted (OR= 1.30, 95% CI= 0.56-3.01) models. Individuals who are overweight/obese were significantly more likely to be diagnosed with GDM when compared with individuals normal weight both the crude (OR= 3.13, 95% CI= 1.28-7.64), and adjusted (OR= 2.44, 95% CI= 1.02-5.86) models. NH-Whites with elevated LDL and increased BMI are significantly more likely to be diagnosed with GDM; NH-Blacks with elevated triglycerides and increased BMI are significantly more likely to be diagnosed with GDM; Mexican-Americans with elevated triglycerides and increased BMI were significantly more likely to be diagnosed with GDM; Individuals of “Other” races with elevated LDL were significantly more likely to be diagnosed with GDM

Conclusion: With the exception of non-Hispanic Whites, pregnant American women with higher levels of cholesterols, high triglycerides, increased body mass index (25 kg/m2 or greater), and less than high school education were found to be at greater risks of diabetes. The result of this analysis suggests that healthcare professionals should be more aggressive in controlling these metabolic abnormalities in pregnant women. Early intervention prior to pregnancy may help delay the onset of prediabetes/diabetes. Empowerment of pregnant women in the management of their diabetes may also be critical in averting the detrimental effect of these metabolic abnormalities.

Available for download on Saturday, December 20, 2014

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