Evidence map›Paper›PMID 41772513›Full record

ArticleBMC pregnancy and childbirth2026

Factors associated with healthcare professionals' use of stigmatizing language in individuals with diabetes in pregnancy.

Anwei Gwan, Isai B Ortiz, Katelyn M Tessier, Renee M Mahr, Anna Ayers Looby, Sanjana Molleti, Jessica Makori, Oluwabukola O Akingbola, Alexander A Boucher, Sereen K Nashif and 2 more

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Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Anwei GwanThe Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, Minnesota, 55455, USA.
Isai B OrtizUniversity of Minnesota Medical School, Minneapolis, Minnesota, USA.
Katelyn M TessierMasonic Cancer Center, Biostatistics Core, University of Minnesota, Minneapolis, Minnesota , USA.
Renee M MahrThe Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, Minnesota, 55455, USA.
Anna Ayers LoobyThe Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, Minnesota, 55455, USA.
Sanjana MolletiUniversity of Minnesota Medical School, Minneapolis, Minnesota, USA.
Jessica MakoriUniversity of Minnesota Medical School, Minneapolis, Minnesota, USA.
Oluwabukola O AkingbolaThe Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, Minnesota, 55455, USA.
Alexander A BoucherDivision of Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
Sereen K NashifThe Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, Minnesota, 55455, USA.
J'Mag KarbeahSchool of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Sarah A WernimontThe Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, Minnesota, 55455, USA. swernimo@umn.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClinicians’ language can influence patient perception and engagement in care. Use of stigmatizing language, including terms such as “noncompliant”, “refused”, “failed”, and “unmotivated”, has been found to contribute to distress among individuals with diabetes in pregnancy. However, it is unclear how often healthcare professionals use stigmatizing language in the electronic health record (EHR) and the clinical factors associated with its use among birthing individuals with diabetes.

methodsA retrospective cohort study was conducted from 2018 to 2019, focusing on individuals with singleton, non-anomalous pregnancies diagnosed with pre-existing or gestational diabetes. We utilized an academic-community obstetric outcomes database, employing a Natural Language Processing (NLP) algorithm to identify stigmatizing terms in electronic health records, including variations of terms such as “failed,” “refused,” “unwilling,” “unmotivated,” “noncompliant,” and “non-adherent.” We then compared the clinical characteristics, outcomes, and glycemic markers of individuals with and without documented stigmatizing language. Unadjusted and adjusted logistic regression models assessed the association of clinical factors on the utilization of stigmatizing language.

resultsOut of 1,433 birthing individuals who met criteria, 128 (8.9%) exhibited stigmatizing language in their records. The most common terms were related to “noncompliant” (47%) and “refused” (42%), primarily used by physicians and nurses. Birthing individuals of color were about four times more likely to have stigmatizing language used in their EHR compared to White individuals (aOR 3.87, 95% CI 2.55–5.99, p < 0.001). Those speaking languages other than English and Spanish were three times more likely to have stigmatizing terms documented (aOR 3.18, 95% CI 1.98–5.01, p < 0.001). Finally, individuals using public insurance were nearly five times more likely to receive stigmatizing descriptions compared to those with private insurance (aOR 4.95, 95% CI 3.26–7.73, p < 0.001). No differences were seen in NICU admission after controlling for diabetes type, and few objective markers of glycemia were identified in the EHR.

conclusionBirthing individuals of color, non-English/non-Spanish speakers, and those on public insurance diagnosed with diabetes in pregnancy were significantly more likely to have stigmatizing language documented within their medical records. Clinicians’ use of stigmatizing language appears disconnected from glycemic concerns.

Indexed as

Diabetes, GestationalHealth PersonnelLanguagePregnancy in DiabeticsSocial StigmaStereotypingAdultElectronic Health RecordsFemaleHumansNatural Language ProcessingPregnancyRetrospective StudiesDiabetesGestational DiabetesLanguageNatural Language ProcessingPregnancyStigmatizing LanguageType 1 DiabetesType 2 diabetes

Identifiers

PMID41772513
PMCPMC13067573

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.