African-American Women Have Higher Initial HbA_lc Levels in Diabetic Pregnancy

Abstract

OBJECTIVE— African-American women with diabetes are at greater risk for poor glycemic control outside of pregnancy. We evaluated the effect of race on glycemic control in a racially mixed population of women with diabetes entering prenatal care.

RESEARCH DESIGN AND METHODS— HbA_lc levels along with demographic data were collected at the first prenatal visit from a group of 234 women with preexisting diabetes. We applied logistic multivariate analysis to identify factors associated with HbA_lc levels above the median for the group.

RESULTS— The median HbA_lc level for the group was 8%. HbA_lc levels were 8.7 ± 2.0% in African-Americans and 7.7 ± 1.5% in Caucasians (P < 0.001). African-American racial designation was significantly and independently associated with high HbA_lc when controlled for maternal age, parity, White classification, diabetes type, education, marital status, obesity, insurance type, and first trimester entry into care. The effect of race was confined to the nonobese patients, for whom the adjusted odds ratio for African-American race as a predictor of high HbA_lc was 8.15 with a 95% CI of 2.41-27.58 (P = 0.001).

CONCLUSIONS— We found a clear racial disparity in glycemic control among women entering prenatal care with preexisting diabetes. This study demonstrates that there generally is need for better glycemic control among reproductive-age women with diabetes, but especially among those who are African-American.