ArticleBJOG : an international journal of obstetrics and gynaecology2024
Rural-urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross-sectional analysis of over 12 million pregnancies.
Article in BJOG : an international journal of obstetrics and gynaecology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Trends in gestational diabetes prevalence in China from 1990 to 2024: a systematic review and meta-analysis.Reviews in endocrine & metabolic disorders · 2025Pooled it
- lncRNA PANDAR predicts adverse pregnancy outcomes and reflects hyperglycemia-associated cellular stress in gestational diabetes mellitus.Journal of endocrinological investigation · 2026Article
- Postpartum Hospital Readmissions Among Women With Gestational Diabetes and Pregestational Diabetes in the United States, 2016 to 2022.Women's health issues : official publication of the Jacobs Institute of Women's Health · 2026Article
- Nationwide trends and geographic variations of diabetes in pregnancy in Thailand: Epidemiology, neonatal outcomes, and healthcare costs under the universal health coverage scheme (2013-2023).Preventive medicine reports · 2026Article
- Diabetes in Pregnant Romanian Patients-Epidemiology and Prevention Strategies Proposal.Journal of clinical medicine · 2025Article
- Hyperglycaemia in pregnancy: the role of ethnicity and geography in risk and outcomes.Diabetologia · 2025Review
- Risk of Adverse Pregnancy Outcomes Among Asian Individuals With Gestational Diabetes Mellitus in the U.S., 2016-2021.Diabetes care · 2025Article
- The impact of social determinants of health on infant and maternal health using a reproductive justice lens.BMC pregnancy and childbirth · 2025Article
- Disparities in Diabetes in Pregnancy and the Role of Social Determinants of Health.Current diabetes reports · 2025Review
- Physical activity during pregnancy and pregnancy related complication.Scientific reports · 2025Article
- Social Inequities in Cardiovascular Disease Risk Factors at Multiple Levels Persist Among Mothers in Texas.International journal of environmental research and public health · 2025Article
- Mapping maternity care deserts: Driving distance and health outcomes in North Carolina.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Exploring the experiences of women and people with diabetes in pregnancy in metropolitan and rural Australia: a national survey.BMC pregnancy and childbirth · 2025Article
- Rural maternal health interventions: A scoping review and implications for best practices.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Trends in Severe Maternal Morbidity, Obstetric Comorbidities, and Birth Complications in Illinois.O&G open · 2024Article
- Who's in the NICU? A population-level analysis.Journal of perinatology : official journal of the California Perinatal Association · 2024Article
- Article
- Examining rurality and social determinants of health among women with GDM: a 15-year comprehensive population analysis.BMC women's health · 2024Article
- Improved pregnancy outcome in gestational diabetes mellitus patients treated with insulin aspart and metformin: a comparative study.American journal of translational research · 2024Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo compare trends in pregestational (DM) and gestational diabetes (GDM) in pregnancy in rural and urban areas in the USA, because pregnant women living in rural areas face unique challenges that contribute to rural-urban disparities in adverse pregnancy outcomes.
designSerial, cross-sectional analysis.
settingUS National Center for Health Statistics (NCHS) Natality Files from 2011 to 2019. POPULATION: A total of 12 401 888 singleton live births to nulliparous women aged 15-44 years.
methodsWe calculated the frequency (95% confidence interval [CI]) per 1000 live births, the mean annual percentage change (APC), and unadjusted and age-adjusted rate ratios (aRR) of DM and GDM in rural compared with urban maternal residence (reference) per the NCHS Urban-Rural Classification Scheme overall, and by delivery year, reported race and ethnicity, and US region (effect measure modification).
main outcome measuresThe outcomes (modelled separately) were diagnoses of DM and GDM.
resultsFrom 2011 to 2019, there were increases in both the frequency (per 1000 live births; mean APC, 95% CI per year) of DM and GDM in rural areas (DM: 7.6 to 10.4 per 1000 live births; APC 2.8%, 95% CI 2.2%-3.4%; and GDM: 41.4 to 58.7 per 1000 live births; APC 3.1%, 95% CI 2.6%-3.6%) and urban areas (DM: 6.1 to 8.4 per 1000 live births; APC 3.3%, 95% CI 2.2%-4.4%; and GDM: 40.8 to 61.2 per 1000 live births; APC 3.9%, 95% CI 3.3%-4.6%). Individuals living in rural areas were at higher risk of DM (aRR 1.48, 95% CI 1.45%-1.51%) and GDM versus those in urban areas (aRR 1.17, 95% CI 1.16%-1.18%). The increased risk was similar each year for DM (interaction p = 0.8), but widened over time for GDM (interaction p < 0.01). The rural-urban disparity for DM was wider for individuals who identified as Hispanic race/ethnicity and in the South and West (interaction p < 0.01 for all); and for GDM the rural-urban disparity was generally wider for similar factors (i.e. Hispanic race/ethnicity, and in the South; interaction p < 0.05 for all).
conclusionsThe frequency of DM and GDM increased in both rural and urban areas of the USA from 2011 to 2019 among nulliparous pregnant women. Significant rural-urban disparities existed for DM and GDM, and increased over time for GDM. These rural-urban disparities were generally worse among those of Hispanic race/ethnicity and in women who lived in the South. These findings have implications for delivering equitable diabetes care in pregnancy in rural US communities.
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