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					Diabetes in Pregnancy in NM


A summary of the available data and what the
numbers can and can’t tell us




Heidi Krapfl, NM Diabetes Prevention and Control Program
September 8, 2006 DAC Meeting

                                                           1
How is Gestational Diabetes
Prevalence Estimated?
Only truly accurate method is to perform
 diagnostic test on all pregnant women
 Some health insurance groups have
 screening protocols (e.g. Kaiser) but not all
 organizations have same protocol
Alternatives include testing after
 determining historic risk factors or a
 glucose challenge test

                                         2
 How is Gestational Diabetes
 Prevalence Estimated?
“Diagnosis in pregnancy” check box
 on birth certificate. US Standard Birth
 Certificate—goal for all states by 2007
Pregnancy Risk Assessment
 Monitoring System (PRAMS)
 http://www.health.state.nm.us/phd/prams/home.html
Hospital Inpatient Discharge Data

                                                3
NM Data Sources and Summaries
 PRAMS 1998-2003: Diabetes Diagnosed before
  or During Pregnancy
           Region                  Diabetes in Pregnancy (%)
           NW                                          8.4%
           NE                                          8.8%
           Bernalillo County                           6.7%
           SE                                          6.1%
           SW                                          8.9%
           Overall                                     7.7%


    It is not correct to interpret this table as indicating the NE and SW have a
    higher % than the NW. From a statistical standpoint, all these % are roughly
    the same. But, Bernalillo is statistically different from the NW, NE, and SW.
    The SE is statistically different from the NW, NE and SW.


                                                                                    4
NM Data Sources and Summaries
 PRAMS 1998-2003: Diabetes before or During
  Pregnancy
                                     Diabetes in Pregnancy (% ) in NM by
                                         Race/Ethnicity: 1998-2003
                   14.0%
                                                              11.7%
                   12.0%
                   10.0%
                    8.0%                      8.1%
                              5.7%                                          5.6%
                    6.0%
                    4.0%
                    2.0%
                    0.0%
                             White          Hispanic          Native        African
                                                             American      American




Whites and African Americans have % that are not statistically different. The % for Native
Americans and Hispanics are statistically different from Whites and African Americans. Also, %
for Native Americans is statistically different from % for Hispanics.                 5
NM Data Sources and Summaries
 PRAMS 1998-2003: Diabetes before or During
  Pregnancy and Weight
                             Weight Problem Pre-Pregnancy
    Diabetes in Pregnancy                56.0%
    No Diabetes in Pregnancy             35.4%


Definitions for weight categories are based on Body Mass Index (BMI). BMI categories for
youth and adults are not entirely comparable. The Chronic Disease Epidemiology Program
developed a variable for all age groups. Adults who are obese or overweight or children who or
overweight or at risk for overweight are referred to as having “a weight problem” or “weighing
too much.” This is a statistically significant difference.




                                                                                    6
NM Data Sources and Summaries

PRAMS 1998-2004
Trends in Diabetes in Pregnancy
 (Diagnosed before or During)
  Year          Diabetes in Pregnancy (%)   95% CI
         1998                          7%   (5.4-9.1)
         1999                       7.4%    (6.0-9.1)
         2000                       7.3%    (6.0-8.8)
         2001                       7.6%    (6.3-9.1)
         2002                       8.6%    (7.2-10.3)
         2003                       8.3%    (6.8-10.1)
         2004                       9.0%    (7.5-10.5)



                                                         7
NM Data Sources and Summaries

PRAMS: 1999, 2004
Gestational Diabetes Only

  Year               GDM Prevalence (%)          95% CI      Number of GDM Women
  1999                     6.0%                 (4.6-7.3)             1500
  2004                     6.9%                 (5.5-8.2)             1820



Prevalence has not increased from 1999 to 2004. However, these are only two data points. More
are needed to evaluate trend.

                                                                                   8
NM Data Sources and Summaries

PRAMS: 1999, 2004
Gestational Diabetes Only
                          1999          95% CI              2004      95% CI
White                     5.6%          (3.3-7.8)           7.6%      (5.0-10.1)
Hispanic                  5.0%          (4-8.0)             7.6%      (5.7-9.5)
Native American           7.7%          (4.4-11.02)        10.3%      (5.5-15.2)




Hispanics and White have similar prevalence in both years. Native Americans are
higher, but not from statistical standpoint. From 1999 to 2004, prevalence may be
increasing for all racial/ethnic groups, but again, need more data to evaluate trend.

                                                                                        9
NM Data Sources and Summaries

Hospital Inpatient Discharge Database
Pregnancy-related discharges at
 individual level
Exclude postpartum discharges
Classify GDM and diabetes in
 pregnancy

                                  10
NM Data Sources and Summaries

Hospital Inpatient Discharge Database
Codes for gestational and diabetes
 diagnosed before pregnancy
Problems with data
  Case where one discharge says GDM
  Another discharge for same person doesn’t
   mention diabetes in pregnancy but has general
   diabetes code.
  How should this woman be classified??
                                           11
Trends of Diabetes in
Pregnancy?
 Overall, trend is towards increasing diabetes in
  pregnancy (PRAMS).
 For GDM, not sure—maybe.
 But study done in Colorado (Diabetes Care 28(3): 579-
  584)
 Title: “Increasing Prevalence of Gestational Diabetes
  Mellitus (GDM) Over Time and by Birth Cohort”
 Standard screening protocol for GDM since 1994


                                                     12
Trends of Diabetes in
Pregnancy?
 From 1994 to 2002, the overall prevalence doubled
  (from 2.1% to 4.1%)
 Increased among White, Hispanic, African American
  and Asian women.
 Hypothesis for increase: obesity and possibly obesity
  associated increase in Type 2, undiagnosed before
  pregnancy.




                                                   13
Conclusions
 Diabetes in pregnancy is increasing in New Mexico
 As age increases, so does risk
 Risk: Native Americans>Hispanics>Whites≈African
  Americans
 The prevalence for all racial/ethnic groups is increasing.
 Pre-pregnancy weight plays an important role
 GDM may be increasing but need more data
 HIDD may not be a good dataset to estimate diabetes in
  pregnancy?
                                                     14
Conclusions/Recommendations
 Work with Vital Records around birth certificate check
  box.
 DPCP currently working with UNM’s Diabetes in
  Pregnancy Program
 Implications of increasing trend—complications, more
  women with type 2 diabetes, etc.
 Need to address diabetes in pregnancy, especially
  among those with transportation issues and/or those
  patients who are indigent.


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