Racial/ethnic disparities in the association of maternal diabetes and obesity with risk of preterm birth among 17 million mother-infant pairs in the United States: a population-based cohort study

Background The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. How...

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Published inBMC pregnancy and childbirth Vol. 25; no. 1; pp. 333 - 10
Main Authors Xie, Juan, Yan, Yuxiang, Ye, Ziyi, Wu, Yuxiao, Yu, Yongfu, Sun, Yangbo, Rong, Shuang, Santillan, Donna A., Ryckman, Kelli, Snetselaar, Linda G., Liu, Buyun, Bao, Wei
Format Journal Article
LanguageEnglish
Published London BioMed Central 21.03.2025
BMC
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Online AccessGet full text
ISSN1471-2393
1471-2393
DOI10.1186/s12884-025-07352-2

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Abstract Background The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth. Methods In this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m 2 ) was classified as underweight (< 18.5 kg/ m 2 ), normal weight (18.5–24.9 kg/m 2 ), overweight (25.0–29.9 kg/m 2 ), obesity class I (30.0–34.9 kg/m 2 ), obesity class II (35.0–39.9 kg/m 2 ), and obesity class III (≥ 40 kg/m 2 ). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28–31 weeks), and moderately (32–36 weeks) preterm birth. Logistic regression models were used for association analyses in this study. Results Among 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34–5.99], normal weight 4.28 [3.98–4.60], overweight 3.29 [3.11–3.49], obesity I 3.09 [2.93–3.26], obesity II 2.98 [2.82–3.16], obesity III 3.19 [3.04–3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91–2.30], normal weight 2.16 [1.90–2.47], overweight 2.71 [2.47–2.97], obesity I 3.10 [2.82–3.41], obesity II 3.58 [3.13–4.09], obesity III 3.99 [3.34–4.77]). The corresponding OR was (underweight 4.33 [3.21–5.83], normal weight 3.69 [3.47–3.93], overweight 3.26 [3.10–3.42], obesity I 3.33 [3.19–3.49], obesity II 3.47 [3.29–3.65], obesity III 3.89 [3.68–4.11]) among Hispanics and (underweight 5.17 [4.34–6.17], normal weight 5.01 [4.83–5.21], overweight 4.98 [4.80–5.17], obesity I 4.66 [4.48–4.85], obesity II 4.58 [4.38–4.79], obesity III 4.50 [4.31–4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67–1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35–1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65–1.78], 1.96 [1.83–2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44–1.48], 1.64 [1.61–1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35–1.40]. Conclusions In conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.
AbstractList Abstract Background The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth. Methods In this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m2) was classified as underweight (< 18.5 kg/ m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class I (30.0–34.9 kg/m2), obesity class II (35.0–39.9 kg/m2), and obesity class III (≥ 40 kg/m2). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28–31 weeks), and moderately (32–36 weeks) preterm birth. Logistic regression models were used for association analyses in this study. Results Among 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34–5.99], normal weight 4.28 [3.98–4.60], overweight 3.29 [3.11–3.49], obesity I 3.09 [2.93–3.26], obesity II 2.98 [2.82–3.16], obesity III 3.19 [3.04–3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91–2.30], normal weight 2.16 [1.90–2.47], overweight 2.71 [2.47–2.97], obesity I 3.10 [2.82–3.41], obesity II 3.58 [3.13–4.09], obesity III 3.99 [3.34–4.77]). The corresponding OR was (underweight 4.33 [3.21–5.83], normal weight 3.69 [3.47–3.93], overweight 3.26 [3.10–3.42], obesity I 3.33 [3.19–3.49], obesity II 3.47 [3.29–3.65], obesity III 3.89 [3.68–4.11]) among Hispanics and (underweight 5.17 [4.34–6.17], normal weight 5.01 [4.83–5.21], overweight 4.98 [4.80–5.17], obesity I 4.66 [4.48–4.85], obesity II 4.58 [4.38–4.79], obesity III 4.50 [4.31–4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67–1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35–1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65–1.78], 1.96 [1.83–2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44–1.48], 1.64 [1.61–1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35–1.40]. Conclusions In conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.
BackgroundThe racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth.MethodsIn this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m2) was classified as underweight (< 18.5 kg/ m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity class I (30.0–34.9 kg/m2), obesity class II (35.0–39.9 kg/m2), and obesity class III (≥ 40 kg/m2). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28–31 weeks), and moderately (32–36 weeks) preterm birth. Logistic regression models were used for association analyses in this study.ResultsAmong 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34–5.99], normal weight 4.28 [3.98–4.60], overweight 3.29 [3.11–3.49], obesity I 3.09 [2.93–3.26], obesity II 2.98 [2.82–3.16], obesity III 3.19 [3.04–3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91–2.30], normal weight 2.16 [1.90–2.47], overweight 2.71 [2.47–2.97], obesity I 3.10 [2.82–3.41], obesity II 3.58 [3.13–4.09], obesity III 3.99 [3.34–4.77]). The corresponding OR was (underweight 4.33 [3.21–5.83], normal weight 3.69 [3.47–3.93], overweight 3.26 [3.10–3.42], obesity I 3.33 [3.19–3.49], obesity II 3.47 [3.29–3.65], obesity III 3.89 [3.68–4.11]) among Hispanics and (underweight 5.17 [4.34–6.17], normal weight 5.01 [4.83–5.21], overweight 4.98 [4.80–5.17], obesity I 4.66 [4.48–4.85], obesity II 4.58 [4.38–4.79], obesity III 4.50 [4.31–4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67–1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35–1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65–1.78], 1.96 [1.83–2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44–1.48], 1.64 [1.61–1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35–1.40].ConclusionsIn conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.
The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth.BACKGROUNDThe racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth.In this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m2) was classified as underweight (< 18.5 kg/ m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obesity class I (30.0-34.9 kg/m2), obesity class II (35.0-39.9 kg/m2), and obesity class III (≥ 40 kg/m2). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28-31 weeks), and moderately (32-36 weeks) preterm birth. Logistic regression models were used for association analyses in this study.METHODSIn this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m2) was classified as underweight (< 18.5 kg/ m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obesity class I (30.0-34.9 kg/m2), obesity class II (35.0-39.9 kg/m2), and obesity class III (≥ 40 kg/m2). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28-31 weeks), and moderately (32-36 weeks) preterm birth. Logistic regression models were used for association analyses in this study.Among 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34-5.99], normal weight 4.28 [3.98-4.60], overweight 3.29 [3.11-3.49], obesity I 3.09 [2.93-3.26], obesity II 2.98 [2.82-3.16], obesity III 3.19 [3.04-3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91-2.30], normal weight 2.16 [1.90-2.47], overweight 2.71 [2.47-2.97], obesity I 3.10 [2.82-3.41], obesity II 3.58 [3.13-4.09], obesity III 3.99 [3.34-4.77]). The corresponding OR was (underweight 4.33 [3.21-5.83], normal weight 3.69 [3.47-3.93], overweight 3.26 [3.10-3.42], obesity I 3.33 [3.19-3.49], obesity II 3.47 [3.29-3.65], obesity III 3.89 [3.68-4.11]) among Hispanics and (underweight 5.17 [4.34-6.17], normal weight 5.01 [4.83-5.21], overweight 4.98 [4.80-5.17], obesity I 4.66 [4.48-4.85], obesity II 4.58 [4.38-4.79], obesity III 4.50 [4.31-4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67-1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35-1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65-1.78], 1.96 [1.83-2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44-1.48], 1.64 [1.61-1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35-1.40].RESULTSAmong 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34-5.99], normal weight 4.28 [3.98-4.60], overweight 3.29 [3.11-3.49], obesity I 3.09 [2.93-3.26], obesity II 2.98 [2.82-3.16], obesity III 3.19 [3.04-3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91-2.30], normal weight 2.16 [1.90-2.47], overweight 2.71 [2.47-2.97], obesity I 3.10 [2.82-3.41], obesity II 3.58 [3.13-4.09], obesity III 3.99 [3.34-4.77]). The corresponding OR was (underweight 4.33 [3.21-5.83], normal weight 3.69 [3.47-3.93], overweight 3.26 [3.10-3.42], obesity I 3.33 [3.19-3.49], obesity II 3.47 [3.29-3.65], obesity III 3.89 [3.68-4.11]) among Hispanics and (underweight 5.17 [4.34-6.17], normal weight 5.01 [4.83-5.21], overweight 4.98 [4.80-5.17], obesity I 4.66 [4.48-4.85], obesity II 4.58 [4.38-4.79], obesity III 4.50 [4.31-4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67-1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35-1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65-1.78], 1.96 [1.83-2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44-1.48], 1.64 [1.61-1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35-1.40].In conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.CONCLUSIONSIn conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.
Background The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth. Methods In this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m 2 ) was classified as underweight (< 18.5 kg/ m 2 ), normal weight (18.5–24.9 kg/m 2 ), overweight (25.0–29.9 kg/m 2 ), obesity class I (30.0–34.9 kg/m 2 ), obesity class II (35.0–39.9 kg/m 2 ), and obesity class III (≥ 40 kg/m 2 ). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28–31 weeks), and moderately (32–36 weeks) preterm birth. Logistic regression models were used for association analyses in this study. Results Among 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34–5.99], normal weight 4.28 [3.98–4.60], overweight 3.29 [3.11–3.49], obesity I 3.09 [2.93–3.26], obesity II 2.98 [2.82–3.16], obesity III 3.19 [3.04–3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91–2.30], normal weight 2.16 [1.90–2.47], overweight 2.71 [2.47–2.97], obesity I 3.10 [2.82–3.41], obesity II 3.58 [3.13–4.09], obesity III 3.99 [3.34–4.77]). The corresponding OR was (underweight 4.33 [3.21–5.83], normal weight 3.69 [3.47–3.93], overweight 3.26 [3.10–3.42], obesity I 3.33 [3.19–3.49], obesity II 3.47 [3.29–3.65], obesity III 3.89 [3.68–4.11]) among Hispanics and (underweight 5.17 [4.34–6.17], normal weight 5.01 [4.83–5.21], overweight 4.98 [4.80–5.17], obesity I 4.66 [4.48–4.85], obesity II 4.58 [4.38–4.79], obesity III 4.50 [4.31–4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67–1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35–1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65–1.78], 1.96 [1.83–2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44–1.48], 1.64 [1.61–1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35–1.40]. Conclusions In conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.
The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth. In this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m ) was classified as underweight (< 18.5 kg/ m ), normal weight (18.5-24.9 kg/m ), overweight (25.0-29.9 kg/m ), obesity class I (30.0-34.9 kg/m ), obesity class II (35.0-39.9 kg/m ), and obesity class III (≥ 40 kg/m ). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28-31 weeks), and moderately (32-36 weeks) preterm birth. Logistic regression models were used for association analyses in this study. Among 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34-5.99], normal weight 4.28 [3.98-4.60], overweight 3.29 [3.11-3.49], obesity I 3.09 [2.93-3.26], obesity II 2.98 [2.82-3.16], obesity III 3.19 [3.04-3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91-2.30], normal weight 2.16 [1.90-2.47], overweight 2.71 [2.47-2.97], obesity I 3.10 [2.82-3.41], obesity II 3.58 [3.13-4.09], obesity III 3.99 [3.34-4.77]). The corresponding OR was (underweight 4.33 [3.21-5.83], normal weight 3.69 [3.47-3.93], overweight 3.26 [3.10-3.42], obesity I 3.33 [3.19-3.49], obesity II 3.47 [3.29-3.65], obesity III 3.89 [3.68-4.11]) among Hispanics and (underweight 5.17 [4.34-6.17], normal weight 5.01 [4.83-5.21], overweight 4.98 [4.80-5.17], obesity I 4.66 [4.48-4.85], obesity II 4.58 [4.38-4.79], obesity III 4.50 [4.31-4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67-1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35-1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65-1.78], 1.96 [1.83-2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44-1.48], 1.64 [1.61-1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35-1.40]. In conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.
ArticleNumber 333
Author Rong, Shuang
Xie, Juan
Wu, Yuxiao
Ryckman, Kelli
Yu, Yongfu
Santillan, Donna A.
Bao, Wei
Yan, Yuxiang
Sun, Yangbo
Snetselaar, Linda G.
Liu, Buyun
Ye, Ziyi
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  surname: Xie
  fullname: Xie, Juan
  organization: Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China
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  givenname: Yuxiang
  surname: Yan
  fullname: Yan, Yuxiang
  organization: Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China
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  givenname: Ziyi
  surname: Ye
  fullname: Ye, Ziyi
  organization: Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China
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  givenname: Yuxiao
  surname: Wu
  fullname: Wu, Yuxiao
  organization: Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China
– sequence: 5
  givenname: Yongfu
  surname: Yu
  fullname: Yu, Yongfu
  organization: Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University
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  givenname: Yangbo
  surname: Sun
  fullname: Sun, Yangbo
  organization: Department of Preventive Medicine, College of Medicine, The University of Tennessee Health Science Center
– sequence: 7
  givenname: Shuang
  surname: Rong
  fullname: Rong, Shuang
  organization: Department of Nutrition, School of Public Health, Wuhan University, Research Center of Public Health, Renmin Hospital of Wuhan University
– sequence: 8
  givenname: Donna A.
  surname: Santillan
  fullname: Santillan, Donna A.
  organization: Department of Obstetrics & Gynecology, University of Iowa
– sequence: 9
  givenname: Kelli
  surname: Ryckman
  fullname: Ryckman, Kelli
  organization: School of Public Health-Bloomington, Indiana University
– sequence: 10
  givenname: Linda G.
  surname: Snetselaar
  fullname: Snetselaar, Linda G.
  organization: Department of Epidemiology, College of Public Health, University of Iowa
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  givenname: Buyun
  surname: Liu
  fullname: Liu, Buyun
  email: buyunliu@ustc.edu.cn
  organization: Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China
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  givenname: Wei
  surname: Bao
  fullname: Bao, Wei
  email: wbao@ustc.edu.cn
  organization: Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China
BackLink https://www.ncbi.nlm.nih.gov/pubmed/40119308$$D View this record in MEDLINE/PubMed
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Issue 1
Keywords Pre-pregnancy obesity
Preterm birth
Diabetes
Race/ethnicity
Language English
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Snippet Background The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is...
The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to...
BackgroundThe racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is...
Abstract Background The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it...
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SubjectTerms Adult
Babies
Body mass index
Cohort analysis
Cohort Studies
Cultural differences
Diabetes
Diabetes, Gestational - epidemiology
Diabetes, Gestational - ethnology
Education
Ethnicity
Ethnicity - statistics & numerical data
Female
Gestational age
Gestational diabetes
Gynecology
Health disparities
Health risks
Health Status Disparities
Hispanic people
Humans
Hypertension
Infant, Newborn
Marital status
Maternal & child health
Maternal and Child Health
Medicine
Medicine & Public Health
Metabolism
Minority & ethnic groups
Mothers
Obesity
Obesity - complications
Obesity - epidemiology
Obesity - ethnology
Obstetrics
Overweight
Pediatrics
Population
Pre-pregnancy obesity
Pregnancy
Pregnancy in Diabetics - ethnology
Premature birth
Premature Birth - epidemiology
Premature Birth - ethnology
Prenatal care
Preterm birth
Race
Race/ethnicity
Reproductive Medicine
Risk Factors
Secondary schools
United States - epidemiology
Vital statistics
Womens health
Young Adult
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Title Racial/ethnic disparities in the association of maternal diabetes and obesity with risk of preterm birth among 17 million mother-infant pairs in the United States: a population-based cohort study
URI https://link.springer.com/article/10.1186/s12884-025-07352-2
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Volume 25
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