Examining Rurality and Social Determinants of Health Among Women with GDM: A 15-year Comprehensive Population Analysis

Abstract

Abstract Background Gestational diabetes mellitus (GDM) is a common pregnancy complication with long-term health consequences for mothers and their children. The escalating trends of GDM coupled with growing prevalence of maternal obesity, a significant GDM risk factor projected to approach nearly 60% by 2030 in Kansas, has emerged as a pressing public health issue. Methods The aim of this study was to compare GDM and maternal obesity trends in rural and urban areas and investigate maternal demographic characteristics influencing the risk of GDM development over a 15-year period. Trend analyses and a binary logistic regression were employed utilizing 2005 to 2019 de-identified birth record vital statistics from the Kansas Department of Health and Environment (N = 589,446). Results Over the cumulative 15-year period, a higher prevalence of GDM was observed in rural areas across age, race/ethnicity, education, and insurance source. Throughout this period, there was an increasing trend in both GDM and overweight or obese pre-pregnancy BMI, with noticeable rural-urban disparities, particularly among rural women with an obese pre-pregnancy BMI. From 2005 to 2019, women, including Asian American Indians (OR: 2.72, 95% CI 2.58%-2.87%), Alaskan Natives (OR: 1.58, 95%, CI 1.44%-1.73%), Hispanics (OR: 1.42, 95% CI 1.37%-1.48%), women residing in rural areas (OR: 1.09, 95%, CI 1.06%-1.12%), with advanced maternal age (35–39 years, OR: 4.52 95% CI 4.24%-4.82%; ≥40 years, OR 5.93 95%, CI 5.47%-6.44%), with lower educational status (less than high school, OR: 1.14, 95% CI 1.10%-1.19%; high school graduate, OR: 1.10, 95% CI 1.06%-1.14%), Medicaid users (OR: 1.10, 95% CI 1.07%-1.14%), unemployed (OR: 1.06, 95% CI 0.97%-1.16%), or with an overweight or obese pre-pregnancy BMI (overweight, OR: 1.78, 95% CI 1.72%-1.84%; obese, OR: 3.60, 95% CI 3.49%-3.72%), were found to be at an increased risk of developing GDM. Conclusions There are persistent rural-urban and racial/ethnic disparities present from 2005 to 2019 among pregnant women in Kansas with or at-risk of GDM. There are several socioeconomic factors that contribute to these health disparities affecting GDM development. These findings, alongside with prominent rising maternal obesity trends, highlights the need to expand GDM services in a predominantly rural state, and implement culturally-responsive interventions for at-risk women.