{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T12:02:55Z","timestamp":1792670575165,"version":"4.5.0"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["HL161514"],"award-info":[{"award-number":["HL161514"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To 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\u2013urban disparities in adverse pregnancy outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Serial, cross\u2010sectional analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>US National Center for Health Statistics (NCHS) Natality Files from 2011 to 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 12\u2009401\u2009888 singleton live births to nulliparous women aged 15\u201344\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We calculated the frequency (95% confidence interval [CI]) per 1000 live births, the mean annual percentage change (APC), and unadjusted and age\u2010adjusted rate ratios (aRR) of DM and GDM in rural compared with urban maternal residence (reference) per the NCHS Urban\u2013Rural Classification Scheme overall, and by delivery year, reported race and ethnicity, and US region (effect measure modification).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>The outcomes (modelled separately) were diagnoses of DM and GDM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 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%\u20133.4%; and GDM: 41.4 to 58.7 per 1000 live births; APC 3.1%, 95% CI 2.6%\u20133.6%) and urban areas (DM: 6.1 to 8.4 per 1000 live births; APC 3.3%, 95% CI 2.2%\u20134.4%; and GDM: 40.8 to 61.2 per 1000 live births; APC 3.9%, 95% CI 3.3%\u20134.6%). Individuals living in rural areas were at higher risk of DM (aRR 1.48, 95% CI 1.45%\u20131.51%) and GDM versus those in urban areas (aRR 1.17, 95% CI 1.16%\u20131.18%). The increased risk was similar each year for DM (interaction <jats:italic>p<\/jats:italic>\u2009=\u20090.8), but widened over time for GDM (interaction <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). The rural\u2013urban disparity for DM was wider for individuals who identified as Hispanic race\/ethnicity and in the South and West (interaction <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01 for all); and for GDM the rural\u2013urban disparity was generally wider for similar factors (i.e. Hispanic race\/ethnicity, and in the South; interaction <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05 for all).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The 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\u2013urban disparities existed for DM and GDM, and increased over time for GDM. These rural\u2013urban 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17587","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T08:29:01Z","timestamp":1687854541000},"page":"26-35","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Rural\u2013urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross\u2010sectional analysis of over 12\u2009million pregnancies"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8043-556X","authenticated-orcid":false,"given":"Kartik K.","family":"Venkatesh","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoning","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie A.","family":"Cameron","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics, Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia C.","family":"Petito","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Medicine The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark B.","family":"Landon","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadiya S.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.7217"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6743a2"},{"issue":"3","key":"e_1_2_12_4_1","first-page":"1","article-title":"Trends and characteristics in gestational diabetes: United States, 2016\u20132020","volume":"71","author":"Gregory E","year":"2022","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2022.100785"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108044"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-2559a"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.110.001032"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17304"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003104"},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-067946","article-title":"Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta\u2010analysis","volume":"377","author":"Ye W","year":"2022","journal-title":"Br Med J"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.3189"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0186287"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3410"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2017.07.005"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.0204"},{"key":"e_1_2_12_17_1","unstructured":"March of Dimes.Nowhere to go: maternity care deserts across the U.S. [cited 2023 May 23]. 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