Disparities in glycated hemoglobin during and beyond pregnancy in a population-based cohort of women with gestational diabetes

项目总结 妊娠期糖尿病(GDM)是一种常见的妊娠并发症，与 种族/民族和移民群体。 糖尿病 在……上面 贡献 患有妊娠期糖尿病的女性患II型糖尿病的风险增加 (T2 DM)，关于妊娠期糖尿病后T2 DM差异的数据表明GDM的影响最大 黑人和西班牙裔女性向2型糖尿病的过渡。因此，GDM差异是至关重要的，因为它们可能 终生治疗2型糖尿病的差异。 有限 妊娠期糖尿病有可能成为T2 DM的早期预警系统 因此，这是一个进行干预的机会，以减少妇女中的T2 DM差距。不幸的是，这个机会 常因长期随访不充分而漏诊。糖化血红蛋白(HbA1C)是一种公认的 T2 DM的诊断工具，以及诊断和控制T2 DM的推荐指南。然而，数据是 缺乏关于妊娠期糖尿病和以人群为基础的长期HbA1c筛查的流行率和预测因素的研究 孕期及产后HbA1c水平的测量。此外，种族/民族和出生地对 这些措施还没有得到充分的调查。填补这一空白的一个主要障碍是缺乏一个大型、 具有有效结果衡量标准的不同GDM队列。我们建议使用关联出生进行二次数据分析 2009-2017年的证书、住院出院和HbA1c登记数据，以构建人口- 以回溯队列为基础。在这个新的妊娠队列中，我们的目标是：1)描述HbA1c的特征 妊娠期糖尿病和非妊娠期糖尿病妇女的产前和产后八年，总体和 种族/族裔/出生地；2)在妊娠期糖尿病妇女中，确定种族/族裔/出生地和 产后长达八年的长期HbA1c检测中的社会经济差异；3)在患有 妊娠期糖尿病，测量种族/民族/出生人口在纵向T2 DM结局(T2 DM和血糖)方面的差异 对照)，并检查产前HbA1c水平和妊娠的临床特征作为不良的预测因素 结果。长期筛查和T2 DM预后差异的发现将在8年的跟踪调查中进行 指导未来的干预措施，将妊娠期糖尿病作为杠杆，预防终生T2 DM差异。

PROJECT SUMMARY Gestational diabetes (GDM) is a common complication of pregnancy with substantial disparities between racial/ethnic and immigrant groups. diabetes on contribute Women with GDM are at an increased risk of later developing Type 2 (T2DM), and data on disparities in T2DM following GDM suggest the greatest effect of GDM the transition to T2DM in black and Hispanic women. Thus GDM disparities are critical because they could to lifecourse T2DM disparities. limited GDM has the potential to be an early warning system for T2DM and therefore is an opportunity to intervene to reduce T2DM disparities in women. Unfortunately, this opportunity is often missed due to inadequate long-term follow-up. Glycosylated hemoglobin (HbA1C) is a well-established diagnostic tool for T2DM, with recommended guidelines for diagnosis and control of T2DM. However, data is scarce about prevalence and predictors of long-term HbA1c screening following GDM, and population-based measures of HbA1c levels during and beyond pregnancy. Further, influence of race/ethnicity and nativity on these measures has not been adequately investigated. A major barrier to filling this gap is the lack of a large, diverse GDM cohort with valid outcome measures. We propose a secondary data analysis using linked birth certificate, hospital discharge, and HbA1c registry data from the years 2009-2017 to construct a population- based retrospective cohort. In this novel pregnancy cohort, we aim to: 1) Characterize HbA1c profiles prenatally and through eight years postpartum in women with and without gestational diabetes, overall and by race/ethnicity/nativity; 2) Among women with a GDM pregnancy, determine racial/ethnic/nativity and socioeconomic disparities in long-term HbA1c testing up to eight years postpartum; 3) Among women with a GDM pregnancy, measure racial/ethnic/nativity disparities in longitudinal T2DM outcomes (T2DM and glucose control) and examine prenatal HbA1c levels and clinical characteristics of pregnancy as predictors of poor outcomes. Discoveries of disparities in long-term screening and T2DM outcomes over 8 years of follow-up will guide future interventions to use GDM as a lever to prevent lifecourse T2DM disparities.