Disparities in Timing of Gestational Diabetes Screening in Hispanic and Caucasian, non-Hispanic Women

Thesis (Master's)--University of Washington, 2012Disparities in Timing of Gestational Diabetes Screening in Hispanic and Caucasian, non-Hispanic Women Carolina Amador Chair of the Supervisory Committee: Professor, Engelberta Thompson Department of Health Services Introduction: Gestational Diabetes Mellitus (GDM) is a common condition of pregnancy affecting 7% of pregnant women. The prevalence of GDM is higher in certain ethnic groups, such as Hispanics and overall prevalence is rising. GDM has implications for the health of both mother and baby. Screening for GDM leads to identification of the condition early enough in pregnancy to prevent potential complications. Prenatal care health disparities are known to exist in previous research studies comparing Hispanic women to Caucasian, non-Hispanic women. An example is in the initiation of prenatal care. Hispanic women tend to initiate prenatal care later in pregnancy than Caucasian women. Purpose: Our primary objective was to determine if Hispanic women were screened for GDM later in pregnancy than a comparable Caucasian group. Our secondary objectives were to determine if disparities existed in the initiation of prenatal care and in the acquisition of six recommended procedures during the first two prenatal visits. Methods: This study utilized a retrospective cohort design based on data extracted from medical records of women delivering at Good Samaritan Regional Medical Center between January 1, 2007 and June 30, 2011. Criteria for inclusion included complete medical record available, insured by Medicaid services, and identification as either Caucasian or Hispanic. Exclusion criteria included having an incomplete medical record, transferring into prenatal care later, and being privately insured. Variables were extracted from the medical records related to the gestational age at which they obtained GDM screening and initiated prenatal care. The acquisition of the six recommended procedures during the first two visits were also recorded for each subject. Variables related to GDM risk were also recorded such as pre-pregnancy BMI and weight gain during pregnancy. In order to describe the groups, they were compared on a number of variables such as age, weight gain during pregnancy, pre-pregnancy BMI, and birthweights of their babies. For the primary research objectives, independent samples t-test was used to determine if there were disparities in gestational age of GDM screening, initiation of prenatal care and in the six recommended procedures. For variables related to GDM risk (pre-pregnancy BMI and weight gain during pregnancy), independent samples t-test were also used to determine differences between the two groups. Binary logistic regression was used to determine if there was a difference in the prevalence positive GDM screen between the two groups. Results: There was no statistically significant difference in the gestational age at which GDM screening was done between the two groups. There was no statistically significant difference in the timing of initiation of prenatal care or the acquisition of six recommended procedures. The rates of positive GDM screens were similar between the two groups after controlling for age. The groups were similar in pre-pregnancy BMI and pregnancy weight gain. The Hispanic women were statistically significantly older than the Caucasian group by 1.8 years. Conclusions: In this study, representing Caucasian and Hispanic women in Corvallis, Oregon, no disparities were seen in gestational age at which GDM screening occurred, in the initiation of prenatal care, or in the acquisition of six recommended procedures. Further study is needed in other measures of prenatal care such as dietary counseling, smoking cessation, labor support, and newborn outcome. Local factors related to collaboration between obstetric care and health department services could have contributed to the lack of disparities seen