African-American women have higher initial HbA1c levels in diabetic pregnancy

OBJECTIVE- African-American women with diabetes are at greater risk for pour glycemic control outside of pregnancy. We evaluated the effect of race on glycemic control in a racially mixed population of women with diabetes entering prenatal care. RESEARCH DESIGN AND METHODS- HbA(1c) levels along with demographic data were collected at the first prenatal visit from a group of 234 women with preexisting diabetes. We applied logistic multivariate analysis to identify factors associated with HbA(1c) levels above the median for the group. RESULTS- The median HbA(1c) level for the group was 8%. HbA(1c) levels were 8.7 +/- 2.0% in African-Americans and 7.7 +/- 1.5% in Caucasians (P < 0.001). African-American racial designation was significantly and independently associated with high HbA(1c) when controlled for maternal age, parity, White classification, diabetes type, education, marital status, obesity insurance type, and first trimester entry into care. The effect of race was confined to the nonobese patients, for whom the adjusted odds ratio for African-American race as a predictor of high HbA(1c) was 8.15 with a 95% CI of 2.41-27.58 (P = 0.001). CONCLUSIONS- We found a clear racial disparity in glycemic control among women entering prenatal care with preexisting diabetes. This study demonstrates that there generally is need for better glycemic control among reproductive-age women with diabetes, but especially among those who are African-American.