Stressful events, smoking exposure and other maternal risk factors associated with gestational diabetes mellitus.

The incidence of gestational diabetes mellitus (GDM) has increased significantly in the last few decades in the US. Understanding its risk factors is imperative for the prevention of GDM and its sequelae, but the roles of behavioural risk factors such as stressful events and smoking on GDM are generally not well understood. Using data obtained from the New York State (NYS) Pregnancy Risk Assessment Monitoring System survey for 2004-06 and the NYS birth certificates, we examined relationships between GDM, stressful events and smoking among 2690 women who had live singleton births and did not have pre-pregnancy diabetes. After adjustment for risk factors such as maternal age, race/ethnicity, pre-pregnancy body mass index, hypertension, as well as smoking exposure, education, parity, and gestation at first visit for prenatal care, we found that having five or more stressful events 12 months before the baby was born was significantly associated with GDM (OR = 2.49, [95% CI 1.49, 4.16]). In another model, having any stressful event(s) other than 'moved to a new address' 12 months before the baby was born was also moderately associated with GDM (OR = 1.38, [95% CI 1.04, 1.85]). Smoking exposure, assessed by combining maternal smoking and second-hand smoke exposure into six levels, had no significant association with GDM, and did not show a dose-response pattern. The present study suggests that stressful events during pregnancy may be an independent risk factor for GDM. Future studies of GDM should include this common, but potentially modifiable risk factor in analyses.

Agreement between self-report and birth certificate for gestational diabetes mellitus: New York State PRAMS.

This study examined agreement (concordance or convergent validity) between self-report and birth certificate for gestational diabetes. Study population was 2,854 women who had live births 2-6 months earlier and responded to a questionnaire from the New York State Pregnancy Risk Assessment Monitoring System (PRAMS) survey, 2004-2006. Agreement between self-report and birth certificate was assessed for the study population overall, and for subgroups defined by race, age, education, marital status, number of previous live births, time of first prenatal care, and birth weight of the newborn. A total of 258 women self-reported gestational diabetes, while birth certificates indicated that 138 women had gestational diabetes. For the study population overall, percent agreement was 93.8% and Kappa was 0.53. Due to the moderate bias index (68.2% overall, ranged from 33.3 to 100% in subgroups) and the high skewed prevalence index (91.8% overall, ranged from 70.7 to 97.5% in subgroups), we determined Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) was a better measure of agreement. PABAK was 0.88 overall, indicating very good agreement. PABAK was uniformly high in all subgroups. The highest PABAK was found among women aged 25 years and younger (0.93), and the lowest PABAK was among Asian women (0.79). Although the absence of a gold standard for gestational diabetes hinders assessment of criterion validity, high PABAK measures suggest that self-reporting by PRAMS respondents is feasible for identifying cases of gestational diabetes for surveillance and population-based epidemiologic research.

Oral health during perinatal period in New York State. Evaluation of 2005 Pregnancy Risk Assessment Monitoring System data.

Perinatal health and oral health behaviors and experiences were evaluated using the 2005 New York State Pregnancy Risk Assessment Monitoring System data. Pregnancy is an opportune time for oral health promotion; however, the data indicated that a substantial proportion of women reportedly did not make a dental visit and/or receive any oral health advice during pregnancy. We discuss the challenges, opportunities and next steps for promoting perinatal oral health programs in New York State.