Diabetes during pregnancy among Métis people in Alberta: a retrospective cohort study

Background:Diabetes in pregnancy is an important public health concern for Indigenous populations. We sought to evaluate the prevalence and outcomes of pre-existing and gestational diabetes among Metis pregnancies compared with other pregnancies in Alberta, Canada.Methods:We conducted a retrospective cohort study using administrative health data from 2006 to 2016 and the Metis Nation of Alberta Identification Registry to compare the prevalence of pre-existing and gestational diabetes among all singleton Metis births with non-Metis births. We compared 10 maternal and neonatal outcomes using adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in multivariable analyses.Results:The study population included 7902 Metis and 471 886 non-Metis births. The age-standardized prevalence of pre-existing diabetes was 1.7% (95% CI 1.4%-2.1%) for Metis and 1.1% (95% CI 1.1%-1.2%) for non-Metis pregnancies. For gestational diabetes, the age-standardized prevalence was 6.3% (95% CI 5.6%-6.9%) for Metis and 5.4% (95% CI 5.3%-5.4%) for non-Metis pregnancies. After adjusting for parity, maternal weight, age, smoking during pregnancy and material and social deprivation, Metis pregnancies had 1.72 times higher prevalence of preexisting diabetes (adjusted OR 1.72, 95% CI 1.15-2.56) and 1.30 times higher prevalence of gestational diabetes (adjusted OR 1.30, 95% CI 1.08-1.57) than non-Metis pregnancies. Metis pregnancies with pre-existing diabetes had nearly 3 times the odds of developing preeclampsia (adjusted OR 2.96, 95% CI 1.27-6.90), while those with gestational diabetes had 48% higher odds of large-for-gestational-age infants (adjusted OR 1.48, 95% CI 1.00-2.19).Interpretation:Metis pregnancies have an increased prevalence of pre-existing and gestational diabetes than non-Metis pregnancies and an elevated risk of some perinatal outcomes. Interventions to tackle these health inequities should address both physiologic and cultural dimensions of health, informed by Metis perspectives.