Racial, ethnic and nativity inequalities in gestational diabetes mellitus: The role of racial discrimination

IntroductionRacial/ethnic minority and foreign-born women in the United States are at high risk of experiencing racial discrimination, which is associated with adverse health outcomes. Although racial discrimination is associated with metabolic disturbances such as insulin resistance and type 2 diabetes, more studies should examine its effect on gestational diabetes mellitus (GDM), which is highest among racial/ethnic minority and foreign-born women. MethodsWe used New York City Pregnancy Risk and Assessment Monitoring System survey data (2012-2014) linked with birth certificate items (N = 4084) in bivariate and multivariate analyses to examine racial/ethnic/nativity differences in racial discrimination, and to test if racial discrimination explains racial/ethnic/nativity inequalities in GDM. ResultsThe 12-month prevalence of racial discrimination (9.5%) varied across race/ethnicity and nativity status, with Black, Hispanic and foreign-born women having the highest prevalence. Interaction effects indicate that US-born Black and Hispanic women are at increased risk of racial discrimination compared to their foreign-born counterparts. Women with GDM had statistically higher prevalence of racial discrimination (14%) compared with women without GDM (9%). Racial discrimination was associated with a 57% increased unadjusted risk of GDM (RR = 1.57, 95% CI [1.19, 2.06]) that decreased to 24% after adjusting for all covariates (RR = 1.24, 95% CI [0.87, 1.78]). DiscussionThe high proportion of racial/ethnic minority and foreign-born women experiencing racial discrimination, and its potential impact on GDM, underscores the importance of culturally informed screening and intervention approaches by trained professionals.