OBJECTIVE To examine whether the association between gestational diabetes mellitus (GDM) and BMI category varies by racial/ethnic group. RESEARCH DESIGN AND METHODS In a cohort of 123,040 women without recognized pregravid diabetes who delivered babies between 1995 and 2006 at Kaiser Permanente of Northern California, we examined racial/ethnic disparities in the prevalence of GDM by BMI category and the population-attributable risk (PAR) associated with overweight/obesity. RESULTS Among all racial/ethnic groups, the age-adjusted prevalence of GDM increased with increasing BMI (kg/m²) category. However, Asian and Filipina women had a prevalence of GDM of 9.9 and 8.5%, respectively, at a BMI of 22.0–24.9 kg/m², whereas in Hispanic, non-Hispanic white, and African American women, the prevalence of GDM was >8.0% at a higher BMI, such as 28–30, 34–36, and ≥37 kg/m², respectively. The estimated PARs suggest that the percentage of GDM that could be prevented if all pregnant women were of normal weight (BMI <25.0 kg/m²) ranging from 65% for African American women to only 23% among Asian women. CONCLUSIONS Clinicians should be aware that the BMI thresholds for increased risk of GDM varies by racial/ethnic group and that the risk is high even at relatively low BMI cutoffs in Asian and Filipina women. Asian women may benefit from different prevention strategies in addition to weight management.

Excessive screen time among children is associated with obesity-promoting health behaviors (ie, increased sedentary behavior and decreased sleep) and adverse mental health (eg, depressive symptoms, anxiety, internalizing and externalizing behaviors, and increased craving behaviors).¹ The COVID-19 pandemic initially led to widespread school closures, shelter-in-place laws, closure of recreational facilities and sports, increases in parents working from home, and social distancing recommendations, all of which may have impacted screen time among children. Increases in screen time during the early phase of the pandemic may have been inevitable as many parents transitioned to work from home and children attended online school. Screen time during the early pandemic period may have been beneficial by allowing children to connect with friends and learn new things outside of school during periods of strict social distancing and remote learning.² However, it is possible that once these behaviors are adopted, they will be hard to reverse, and whether the pandemic resulted in long-term changes in children’s screen time remains unclear.

OBJECTIVE—While women with prior gestational diabetes mellitus (GDM) are more likely to display features of the metabolic syndrome, including hypertension, in the years after delivery, it is unclear whether these components are also present before pregnancy. We examined the relationship between blood pressure (BP) measured before and during early pregnancy (<20 weeks) and the risk of GDM in a nested case-control study. RESEARCH DESIGN AND METHODS—Case (n = 381) and control (n = 942) subjects were selected from a cohort of women delivering between 1996 and 1998 and screened for GDM between 24 and 28 weeks’ gestation. GDM was defined by the National Diabetes Data Group criteria. BP and covariates data were obtained by review of the medical records. Women were categorized according to BP levels recommended by the American Heart Association outside of pregnancy: <120/80 mmHg (normal), 120–139/80–89 mmHg (prehypertension), and ≥140 and/or ≥90 mmHg or use of antihypertensive medications (hypertension). RESULTS—During early pregnancy, women with prehypertension had a small increased risk of GDM (odds ratio [OR] 1.56 [95% CI 1.16–2.10]), and women with hypertension had a twofold increased risk of GDM (2.04 [1.14–3.65]) compared with women with normal BP after adjusting for age, race/ethnicity, gestational week of BP, BMI, and parity. Similar results were seen among the subset of women with BP levels measured before pregnancy (1.44 [0.95–2.19] for prehypertension and 2.01 [1.01–3.99] for hypertension). CONCLUSIONS—Clinicians should be aware that women presenting with hypertension may warrant early screening or intervention to prevent GDM.

OBJECTIVE: To evaluate implementation of an enhanced recovery after surgery (ERAS) program for patients undergoing elective cesarean delivery by comparing opioid exposure, multimodal analgesia use, and other process and outcome measures before and after implementation. METHODS: An ERAS program was implemented among patients undergoing elective cesarean delivery in a large integrated health care delivery system. We conducted a pre–post study of ERAS implementation to compare changes in process and outcome measures during the 12 months before and 12 months after implementation. RESULTS: The study included 4,689 patients who underwent an elective cesarean delivery in the 12 months before (pilot sites: March 1, 2015–February 29, 2016, all other sites: October 1, 2015–September 30, 2016), and 4,624 patients in the 12 months after (pilot sites: April 1, 2016–March 31, 2017, all other sites: November 1, 2016–October 31, 2017) ERAS program implementation. After ERAS implementation mean inpatient opioid exposure (average daily morphine equivalents) decreased from 10.7 equivalents (95% CI 10.2–11.3) to 5.4 equivalents (95% CI 4.8–5.9) controlling for age, race–ethnicity, prepregnancy body mass index, patient reported pain score, and medical center. The use of multimodal analgesia (ie, acetaminophen and neuraxial anesthesia) increased from 9.7% to 88.8%, the adjusted risk ratio (RR) for meeting multimodal analgesic goals was 9.13 (RR comparing post-ERAS with pre-ERAS; 95% CI 8.35–10.0) and the proportion of time patients reported acceptable pain scores increased from 82.1% to 86.4% (P<.001). Outpatient opioids dispensed at hospital discharge decreased from 85.9% to 82.2% post-ERAS (P<.001) and the average number of dispensed pills decreased from 38 to 26 (P<.001). The hours to first postsurgical ambulation decreased by 2.7 hours (95% CI −3.1 to −2.4) and the hours to first postsurgical solid intake decreased by 11.1 hours (95% CI −11.5 to −10.7). There were no significant changes in hospital length of stay, surgical site infections, hospital readmissions, or breastfeeding rates. CONCLUSIONS: Implementation of an ERAS program in patients undergoing elective cesarean delivery was associated with a reduction in opioid inpatient and outpatient exposure and with changes in surgical process measures of care without worsened surgical outcomes.

OBJECTIVE To examine whether circulating total and high–molecular weight (HMW) adiponectin concentrations, measured before pregnancy, are associated with subsequent risk of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS This was a nested case-control study among women who participated in the Kaiser Permanente Northern California Multiphasic Health Check-up exam (1984–1996) with a serum sample obtained and who had a subsequent pregnancy (1984–2009). Eligible women were free of recognized diabetes. Case subjects were the 256 women who developed GDM. Two control subjects were selected for each case and matched for year of blood draw, age at exam, age at pregnancy, and number of intervening pregnancies. RESULTS Compared with the highest quartile of adiponectin, the risk of GDM increased with decreasing quartile (odds ratio [OR] 1.5 [95% CI 0.7–2.9], 3.7 [1.9–7.2], and 5.2 [2.6–10.1]; P_trend <0.001) after adjustment for family history of diabetes, BMI, parity, race/ethnicity, cigarette smoking, and glucose and insulin concentrations. Similar estimates were observed for HMW (P_trend <0.001). The combined effects of having total adiponectin levels below the median (<10.29 mg/mL) and being overweight or obese (BMI ≥25.0 kg/m²) were associated with a sevenfold increased risk of GDM compared with normal-weight women with adiponectin levels above the median (OR 6.7 [95% CI 3.6–12.5]). CONCLUSIONS Prepregnancy low adiponectin concentrations, a marker of decreased insulin sensitivity and altered adipocyte endocrine function, is associated with reduced glucose tolerance during pregnancy and may identify women at high risk for GDM to target for early intervention.