The relationship between high/low birth weights and future development of diabetes mellitus among aboriginal people : a case-control study using Saskatchewan's health data systems

Abstract

In recent decades, rates of type 2 diabetes mellitus (T2DM) and diabetic complications have reached epidemic proportions among Canadian Aboriginal people. Evidence in several populations suggests that abnormal birth weight, particularly low birth weight (LBW) and possibly high birth weight (HBW) may be linked to the development of T2DM. LBW often reflects poor maternal health/ nutritional status which may interfere with normal pancreatic development. HBW is a frequent complication of diabetic pregnancies which are associated with obesity and carbohydrate intolerance in adulthood. Since Saskatchewan Aboriginal newborns historically had higher rates of LBW, and more recently have experienced higher HBW rates, it follows that sub-optimal maternal/ fetal health may be important in the epidemic of T2DM in this population. This thesis describes a case-control study that used Saskatchewan Health databases to determine the relationship between birth weight and T2DM. A sample of 846 adult diabetic Registered Indians (RI) were age and sex matched to three control groups: 1) non-diabetic RI, 2) diabetic general population (GP) subjects, and 3) non-diabetic GP subjects. RI subjects were identified as such by the provincial Health Insurance Registration File. The results of this study show a significant association between HBW (> 4000 grams) and T2DM for RI people [odds ratio (OR) 1.63; 95% confidence interval (CI) 1.20, 2.24]. This association increased in strength from the middle to the latter part of this century and was found to be stronger for RI females than RI males. The comparison of birth weights within the four study groups revealed that diabetic RI (16.2%) were significantly more likely (p