Gestational Diabetes Is Rising Across the U.S., but American Indian Women Bear the Heaviest Burden

By Joe Morey

Rez Life News Editor

CHICAGO — Gestational diabetes has risen steadily in the United States for nearly a decade, increasing every single year from 2016 through 2024, according to a new national analysis from Northwestern Medicine. The study, which examined more than 12 million U.S. births, found that rates climbed across every racial and ethnic group. However, the burden has fallen disproportionately on American Indian and Alaska Native women, who continue to experience the highest rates in the nation.

Researchers found that gestational diabetes cases increased by 36 percent during the nine-year period, rising from 58 cases per 1,000 births in 2016 to 79 cases per 1,000 births in 2024. The findings were published December 29 in JAMA Internal Medicine and update earlier research confirming nearly 15 years of uninterrupted increases nationwide.

“Gestational diabetes has been persistently increasing for more than 10 years, which means whatever we have been trying to do to address diabetes in pregnancy has not been working,” said Dr. Nilay Shah, assistant professor of cardiology at Northwestern University Feinberg School of Medicine and senior author of the study.

Gestational diabetes is a form of glucose intolerance first diagnosed during pregnancy. It raises the risk of pregnancy complications, including high birth weight, premature delivery, and cesarean sections. It also significantly increases the likelihood that both mother and child will later develop type 2 diabetes and cardiovascular disease.

Shah said the trend reflects a broader decline in health among younger Americans.

“The health of young adults has been persistently worsening,” Shah said. “Less healthful diets, less exercise, and rising obesity levels likely underlie why the rates of diabetes during pregnancy have gone up.”

Disparities Across Racial and Ethnic Groups

While the increase was observed in every population group studied, the analysis revealed stark disparities. Women who are American Indian or Alaska Native, Asian, Native Hawaiian, or Pacific Islander experienced substantially higher rates of gestational diabetes than other groups.

In 2024, the study found the following rates per 1,000 births:

137 among American Indian and Alaska Native women

131 among Asian women

126 among Native Hawaiian and Pacific Islander women

85 among Hispanic women

71 among white women

67 among Black women

“These populations tend to be the least well-represented in health research, so we actually understand very little about why these groups have such high rates,” Shah said.

Emily Lam, a third-year medical student at Northwestern Feinberg and the study’s first author, noted that even within broader racial categories, significant variation exists that often goes unrecognized.

“We saw a lot of variation within Asian and Hispanic groups, which often gets overlooked in research,” Lam said.

A Longstanding Diabetes Crisis in American Indian Communities

For American Indian and Alaska Native women, high gestational diabetes rates exist within a broader context of elevated diabetes prevalence overall. According to the Centers for Disease Control and Prevention, American Indian and Alaska Native adults have the highest rate of diagnosed diabetes of any racial or ethnic group in the United States, with prevalence nearly two to three times higher than that of non-Hispanic white adults.

The Indian Health Service has reported that in some tribal communities, more than half of adults are living with type 2 diabetes. Research published in the journal Current Diabetes Reports has shown that American Indian women are nearly twice as likely to develop gestational diabetes compared with non-Hispanic white women and are significantly more likely to progress to type 2 diabetes after pregnancy.

In the Upper Midwest, the diabetes burden among Native communities has been documented for decades, including in Ojibwe and other Great Lakes Tribal populations.

The Great Lakes Inter Tribal Epidemiology Center serves the Indian Health Service Bemidji Area, which includes many Ojibwe communities across Minnesota, Wisconsin and Michigan. In its 2016 regional profile, the center reported the large gap in diabetes prevalence noted above, along with higher obesity rates and other chronic disease indicators among American Indian and Alaska Native adults compared with the overall population.

State data shows the broader diabetes backdrop in which pregnancy-related risk is rising. Minnesota’s Department of Health reported that in 2024, 10.5 percent of Minnesota adults had diagnosed diabetes, about 470,000 people.

 In Wisconsin, the Wisconsin Department of Health Services reported that American Indians have higher diabetes rates than the total state population when adjusting for age distribution differences.

National and state-level summaries often mask the depth of disparity for Native residents. For example, America’s Health Rankings reported that American Indian and Alaska Native adults in Minnesota had a diabetes prevalence of 20.4 percent, far above the state’s overall rate.

Why Diabetes Rates Are Highest Among American Indian Women

Health experts and researchers cite several interconnected factors contributing to the disproportionately high rates of diabetes, both gestational and type 2, among American Indian women.

Obesity and metabolic risk

According to research published by the National Institutes of Health, higher rates of obesity and metabolic syndrome among American Indian populations are strongly associated with increased diabetes risk. Elevated body mass index prior to pregnancy is one of the strongest predictors of gestational diabetes.

Food access and nutrition

The U.S. Department of Agriculture and multiple public health studies have documented higher rates of food insecurity in American Indian communities. Limited access to fresh, affordable, and culturally appropriate foods contributes to diets high in processed carbohydrates and sugars, which increase the risk of insulin resistance and diabetes.

Socioeconomic barriers and healthcare access

According to the Indian Health Service and the Centers for Disease Control and Prevention, American Indian and Alaska Native populations face persistent barriers to preventive care, including underfunded healthcare systems, limited prenatal services in rural areas, and higher rates of poverty. These factors can delay screening, diagnosis, and early management of gestational diabetes.

Historical trauma and lifestyle disruption

Researchers writing in The American Journal of Public Health have linked the high prevalence of diabetes in Indigenous populations to historical displacement, loss of traditional food systems, and forced lifestyle changes. These disruptions, combined with genetic susceptibility to metabolic disease, have contributed to long-term health consequences that persist across generations.

Intergenerational Consequences

Gestational diabetes does not end with childbirth. According to the National Institutes of Health, women who develop gestational diabetes face a much higher lifetime risk of type 2 diabetes. Their children are also more likely to experience obesity, glucose intolerance, and diabetes later in life.

“These data clearly show that we are not doing enough to support the health of the U.S. population, especially young women before and during pregnancy,” Shah said. “Public health and policy interventions should focus on helping all people access high-quality care and have the time and means to maintain healthful behaviors.”

The Northwestern authors emphasized that the continuous rise from 2016 to 2024 suggests current approaches are not bending the curve, and that prevention must start earlier, before pregnancy, while also improving access to high-quality care during pregnancy.

In Tribal and urban Indian health settings, that typically means expanding culturally grounded nutrition and activity supports, improving screening and follow-up after delivery, and strengthening access to consistent primary care so that gestational diabetes does not become the start of lifelong diabetes for mother and child.