J Racial Ethn Health Disparities. 2023 Aug;10(4):1721-1734. doi: 10.1007/s40615-022-01356-w. Epub 2022 Jul 11.


Luciana E Hebert  1   2 Cassandra J Nikolaus  3   4 Anna Zamora-Kapoor  3   4   5 Ka’imi A Sinclair  3   6



Objective: To examine risk factors for gestational diabetes mellitus (GDM) and factors associated with breastfeeding patterns among women with GDM from different racial/ethnic groups.

Methods: We used data from Phase 8 (2016-2018) of the Pregnancy Risk Assessment Monitoring System. We used logistic regression to estimate factors associated with GDM and with breastfeeding initiation, and conducted survival analysis using Kaplan-Meier curves, and Cox proportional hazards regression to analyze early cessation of breastfeeding.

Results: Among American Indian and Alaska Native (AI/AN) women, higher education reduced odds (aOR = 0.33; 95% CI: 0.19-0.59) and being married increased odds (aOR = 1.35; 95% CI: 1.02-1.79) of GDM. AI/AN women who received WIC benefits had lower odds of initiating breastfeeding (aOR = 0.70; 95% CI: 0.51-0.95). While there was no association between GDM and initiation of breastfeeding, only a third of AI/AN women with GDM were still breastfeeding by 36 weeks postpartum, compared to more than half of non-Hispanic White and Hispanic women.

Conclusions for practice: Efforts to reduce GDM among those most at risk are needed, especially among racial and ethnic minorities. Increasing support for women with GDM to continue to breastfeed may improve maternal and child health outcomes and reduce health disparities, particularly among AI/AN women.

Keywords: Alaska Native; American Indian; Breastfeeding; Gestational diabetes; PRAMS; Pregnancy.

© 2022. W. Montague Cobb-NMA Health Institute.

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