Prevalence and associated social determinants of health for pregestational and gestational diabetes mellitus in California by disaggregated racial and ethnic groups and subgroups.

Abstract

Pregestational diabetes (PDM) and gestational diabetes mellitus (GDM) have increased in the U.S., with persistent racial/ethnic disparities. We examined PDM and GDM prevalence and associated social determinants of health (SDOH) across disaggregated racial/ethnic subgroups in California. We included 1,627,679 pregnant women with singleton births (2013-2022) from the California birth certificate database. We estimated age-standardized prevalence, annual percent change (APC), and prevalence ratios (PRs) for SDOH associated with PDM and GDM. From 2013 to 2022, PDM prevalence increased 1.8-fold (0.4% to 0.7%; APC = 7.7%) and GDM increased 1.5-fold (4.8% to 7.2%; APC = 5.1%). Asian and Hawaiian/Pacific Islander experienced the largest APC for both PDM (10.6%) and GDM (6.4%). Hawaiian/Pacific Islander (2.1%) and Hmong (1.3%) women had the highest PDM prevalence, while Hmong (12.1%) and Asian Indian (10.5%) women had the highest GDM. Lower education level was associated with higher PDM (PR = 1.76 [1.67, 1.85]) and GDM (1.15 [1.13, 1.17]). Foreign-born was associated with lower PDM (0.91 [0.87, 0.96]), but higher GDM (1.24 [1.22, 1.25]), with large variations across subgroups. Prenatal Medicaid vs. private insurance was associated with higher GDM, excepting Korean and Vietnamese. PDM and GDM prevalence increased across all racial/ethnic groups in California, with pronounced heterogeneous SDOH associations across disaggregated subgroups.