The objectives of this research were to determine the prevalence of gestational diabetes mellitus (GDM) among the Cree of James Bay, identify independent risk factors for GDM and infant macrosomia in this population and compare the risk for GDM and infant macrosomia among Cree women with Canadian non-Native women. The prevalence of GDM using the National Diabetes Data Group criteria among the Cree was 12.8% (95% CI: 10.1--15.5), among the highest ever reported for an Aboriginal group. Independent risk factors for GDM among the Cree were advanced age, pregravid overweight and previous GDM. A comparison of risk of GDM between Cree and non-Native women revealed a significant interaction between ethnicity and pregravid weight. Overweight Cree women were at an elevated risk for GDM compared with overweight non-Native women (OR: 2.3, 95% CI: 1.3--3.8), whereas the risk for GDM was not statistically different between normal weight Cree and non-Native women (OR: 1.4, 95% CI: 0.7--2.7) after adjusting for age, parity, and smoking status. Mean birth weight among Cree infants was 3859 +/- 519 g, the highest reported for any ethnic group in the world. Macrosomia prevalence was also high at 34.3%. Independent risk factors for macrosomia among the Cree were advanced age, pregravid overweight and GDM. A significant interaction was noted between ethnicity and GDM on risk for macrosomia. GDM increased the risk for macrosomia 4.5-fold among the Cree but had no significant effect among non-Natives. After adjusting for age, parity, pregravid weight, gestational weight gain, GDM, gestational duration and smoking status, Cree infants remained heavier than non-Native infants by 235 g. The results of this research indicate the need to control pregravid obesity through culturally acceptable dietary modifications and exercise in order to minimize the risk for GDM among Cree women. The significant impact of GDM on risk for macrosomia among the Cree calls for the re-evaluation of the existi

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Gestational diabetes mellitus (GDM) and infant macrosomia are important obstetric health concerns for Aboriginal populations in Canada. Previous research in non-Aboriginal populations has established that GDM and macrosomia are associated with increased risk of fetal morbidity. Specifically, GDM is a risk factor for infant macrosomia, hypoglycemia, polycythemia, hypocalcemia, and hyperbilirubinemia. Furthermore, macrosomia is an independent risk factor for shoulder dystocia, clavicular fracture, brachial plexus injury, birth asphyxia and operative delivery. The main objectives of this study were to determine prevalence rates of GDM and macrosomia related neonatal complications for the James Bay Cree population of northern Quebec, and to identify risk factors for specific birth trauma injuries and metabolic complications in the population. The prevalence of macrosomia (≥4500 g) was 10.4%, and the estimated prevalence of GDM was 16.6% (95% CI 14.6-18.6) (n = 229/1379). Shoulder dystocia was the most common birth trauma event among the Cree, affecting 2.5% (n = 42/1650) of all Cree births, and 9.3% (n = 16/172) of macrosomic deliveries ≥4500 g. The prevalence of neonatal hypoglycemia was also high, affecting 8.8% (n = 144/1650) of all Cree newborns, and 18.1% (n = 34/192) of GDM deliveries. Macrosomia (BW ≥ 4500 g) was a significant risk factor for shoulder dystocia, clavicular fracture, hypoglycemia, and caesarean section delivery. After adjusting for maternal age, parity, and gestational age, GDM was identified as a significant risk factor for macrosomia (≥4500 g), hypoglycemia, polycythemia, and hypocalcemia. In summary, this study identified a high incidence of neonatal complications among the James Bay Cree compared with rates in the general North American population. These outcomes can be explained, in part, by high prevalence rates of gestational diabetes and infant macrosomia. Further studies to investigate the long-term consequences of GDM and

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