Pregnancy-Associated Diabetes Mellitus and Stillbirths by Race and Ethnicity among Hospitalized Pregnant Women in the United States.

OBJECTIVES: Racial disparities in preexisting diabetes mellitus (PDM) and gestational diabetes mellitus (GDM) remain largely unexplored. We examined national PDM and GDM prevalence trends by race/ethnicity and the association between these conditions and fetal death. METHODS: This was a retrospective cross-sectional analysis of 69,539,875 pregnancy-related hospitalizations from 2002 to 2017 including 674,040 women with PDM (1.0%) and 2,960,797 (4.3%) with GDM from the US Nationwide Inpatient Sample Survey. Joinpoint regression was used to evaluate trends in prevalence. Survey logistic regression was used to evaluate the association between exposures (PDM and GDM) and outcome. RESULTS: Overall, the average annual increase in prevalence was 5.2% (95% confidence interval [CI] 4.2-6.2) for GDM and 1.0% (95% CI -0.1 to 2.0) for PDM, during the study period. Hispanic (average annual percentage change 5.3, 95% CI 3.6 - 7.1) and non-Hispanic Black (average annual percentage change 0.9, 95% CI 0.1 - 1.7) women had the highest average annual percentage increase in the prevalence of GDM and PDM, respectively. After adjustment, the odds of stillbirth were highest for Hispanic women with PDM (odds ratio 2.41, 95% CI 2.23-2.60) and decreased for women with GDM (odds ratio 0.51, 95% CI 0.50-0.53), irrespective of race/ethnicity. CONCLUSIONS: PDM and GDM prevalence is increasing in the United States, with the highest average annual percentage changes seen among minority women. Furthermore, the reasons for the variation in the occurrence of stillbirths among mothers with PDM and GDM by race/ethnicity are not clear and warrant additional research.

Sex and the cost of reproduction through the life course of an extremely long-lived herb.

Despite being central concepts for life history theory, little is known about how reproductive effort and costs vary with individual age once plants have started to reproduce. We conducted a 5-year field study and estimated age-dependent reproductive effort for both sexes in the extraordinarily long-lived dioecious plant Borderea pyrenaica. We also evaluated costs of reproduction on vital rates for male and female plants, both by examining effects of differences in individual reproductive effort under natural conditions, and by conducting a flower removal experiment, aimed at decreasing reproductive effort. Reproductive effort was fairly constant and independent of age for males, which may reflect a strategy of adjusting overall reproductive output by spreading reproduction over the life course. Females had a higher total effort, which first increased and then decreased with age. The latter may be a response to an increasing reproductive value-an inverse of a terminal investment-or a sign of reproductive senescence due to an age-related physiological decline. Seed production was lower in plants with higher previous reproductive effort and this effect increased with age. We found no evidence for costs of reproduction on other vital rates for either sex. Experimental flower removal only resulted in progressively more negative effects on flower production in older male plants, whereas female vital rates were unaffected. Overall, this study demonstrates that not only sex, but also age influences resource allocation trade-offs and, thus, plant life history evolution.