BMI and risk of gestational diabetes among women of South Asian and Chinese ethnicity: a population-based study

doi:10.1007/s00125-020-05356-5

. 2021 Apr;64(4):805-813.

doi: 10.1007/s00125-020-05356-5. Epub 2021 Jan 24.

BMI and risk of gestational diabetes among women of South Asian and Chinese ethnicity: a population-based study

Stephanie H Read^{1

2}, Laura C Rosella^{2

3

4}, Howard Berger⁵, Denice S Feig^{2

6

7

8}, Karen Fleming⁹, Joel G Ray^{2

6

7

10}, Baiju R Shah^{2

6

7

11}, Lorraine L Lipscombe^{12

13

14

15}

Affiliations

¹ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
² ICES, Toronto, ON, Canada.
³ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Public Health Ontario, Toronto, ON, Canada.
⁵ Division of Maternal-Fetal Medicine, St Michael's Hospital, Toronto, ON, Canada.
⁶ Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁸ Sinai Health System, Toronto, ON, Canada.
⁹ Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁰ Department of Obstetrics and Gynaecology, St Michael's Hospital, Toronto, ON, Canada.
¹¹ Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹² Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. Lorraine.lipscombe@wchospital.ca.
¹³ ICES, Toronto, ON, Canada. Lorraine.lipscombe@wchospital.ca.
¹⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada. Lorraine.lipscombe@wchospital.ca.
¹⁵ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Lorraine.lipscombe@wchospital.ca.

PMID: 33486538
DOI: 10.1007/s00125-020-05356-5

BMI and risk of gestational diabetes among women of South Asian and Chinese ethnicity: a population-based study

Stephanie H Read et al. Diabetologia. 2021 Apr.

. 2021 Apr;64(4):805-813.

doi: 10.1007/s00125-020-05356-5. Epub 2021 Jan 24.

Authors

Affiliations

¹ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
² ICES, Toronto, ON, Canada.
³ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Public Health Ontario, Toronto, ON, Canada.
⁵ Division of Maternal-Fetal Medicine, St Michael's Hospital, Toronto, ON, Canada.
⁶ Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁸ Sinai Health System, Toronto, ON, Canada.
⁹ Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁰ Department of Obstetrics and Gynaecology, St Michael's Hospital, Toronto, ON, Canada.
¹¹ Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹² Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. Lorraine.lipscombe@wchospital.ca.
¹³ ICES, Toronto, ON, Canada. Lorraine.lipscombe@wchospital.ca.
¹⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada. Lorraine.lipscombe@wchospital.ca.
¹⁵ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Lorraine.lipscombe@wchospital.ca.

PMID: 33486538
DOI: 10.1007/s00125-020-05356-5

Abstract

Aims/hypothesis: The aim of this study was to examine how BMI influences the association between Asian ethnicity and risk of gestational diabetes (GDM).

Methods: This population-based cohort study included pregnant women without pre-existing diabetes mellitus in Ontario, Canada between 2012 and 2014. Women of Chinese and South Asian ethnicity were identified using a validated surname algorithm. GDM was ascertained using hospitalisation codes. The relationship between ethnicity and GDM was modelled using modified Poisson regression, adjusted for maternal age, pre-pregnancy BMI, parity, previous GDM, long-term residency status, income quintile and smoking status. An interaction term between ethnicity and pre-pregnancy BMI was tested.

Results: Of 231,618 pregnant women, 9289 (4.0%) were of South Asian ethnicity and 12,240 (5.3%) were of Chinese ethnicity. Relative to women from the general population, in whom prevalence of GDM was 4.3%, the adjusted RR of GDM was higher among those of South Asian ethnicity (1.81 [95% CI 1.64, 1.99]) and Chinese ethnicity (1.66 [95% CI 1.53, 1.80]). The association between GDM and Asian ethnicity remained significant across BMI categories but differed according to BMI. The prevalence of GDM exceeded 5% at an estimated BMI of 21.5 kg/m² among South Asian women, 23.0 kg/m² among Chinese women and 29.5 kg/m² among the general population.

Conclusions/interpretation: The risk of GDM is significantly higher in South Asian and Chinese women, whose BMI is lower than that of women in the general population. Accordingly, targeted GDM prevention strategies may need to consider lower BMI cut-points for Asian populations.

Keywords: Diabetes; Immigrants; Pregnancy; Race; Racial disparities.

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References

1. Eades CE, Cameron DM, Evans JMM (2017) Prevalence of gestational diabetes mellitus in Europe: a meta-analysis. Diabetes Res Clin Pract 129:173–181. https://doi.org/10.1016/j.diabres.2017.03.030 - DOI - PubMed
1. Fadl HE, Östlund IKM, Magnuson AFK, Hanson USB (2010) Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003. Diabet Med 27(4):436–441. https://doi.org/10.1111/j.1464-5491.2010.02978.x - DOI - PubMed
1. Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL (2020) Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ 369:m1361. https://doi.org/10.1136/bmj.m1361 - DOI - PubMed - PMC
1. Hedderson MM, Williams MA, Holt VL, Weiss NS, Ferrara A (2008) Body mass index and weight gain prior to pregnancy and risk of gestational diabetes mellitus. Am J Obstet Gynecol 198(4):409.e401-407. https://doi.org/10.1016/j.ajog.2007.09.028 - DOI - PubMed - PMC
1. Chu SY, Callaghan WM, Kim SY et al (2007) Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 30(8):2070–2076. https://doi.org/10.2337/dc06-2559a - DOI - PubMed

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[1] Eades CE, Cameron DM, Evans JMM (2017) Prevalence of gestational diabetes mellitus in Europe: a meta-analysis. Diabetes Res Clin Pract 129:173–181. https://doi.org/10.1016/j.diabres.2017.03.030 - DOI - PubMed

[2] Eades CE, Cameron DM, Evans JMM (2017) Prevalence of gestational diabetes mellitus in Europe: a meta-analysis. Diabetes Res Clin Pract 129:173–181. https://doi.org/10.1016/j.diabres.2017.03.030 - DOI - PubMed

[3] Fadl HE, Östlund IKM, Magnuson AFK, Hanson USB (2010) Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003. Diabet Med 27(4):436–441. https://doi.org/10.1111/j.1464-5491.2010.02978.x - DOI - PubMed

[4] Fadl HE, Östlund IKM, Magnuson AFK, Hanson USB (2010) Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003. Diabet Med 27(4):436–441. https://doi.org/10.1111/j.1464-5491.2010.02978.x - DOI - PubMed

[5] Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL (2020) Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ 369:m1361. https://doi.org/10.1136/bmj.m1361 - DOI - PubMed - PMC

[6] Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL (2020) Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ 369:m1361. https://doi.org/10.1136/bmj.m1361 - DOI - PubMed - PMC

[7] Hedderson MM, Williams MA, Holt VL, Weiss NS, Ferrara A (2008) Body mass index and weight gain prior to pregnancy and risk of gestational diabetes mellitus. Am J Obstet Gynecol 198(4):409.e401-407. https://doi.org/10.1016/j.ajog.2007.09.028 - DOI - PubMed - PMC

[8] Hedderson MM, Williams MA, Holt VL, Weiss NS, Ferrara A (2008) Body mass index and weight gain prior to pregnancy and risk of gestational diabetes mellitus. Am J Obstet Gynecol 198(4):409.e401-407. https://doi.org/10.1016/j.ajog.2007.09.028 - DOI - PubMed - PMC

[9] Chu SY, Callaghan WM, Kim SY et al (2007) Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 30(8):2070–2076. https://doi.org/10.2337/dc06-2559a - DOI - PubMed

[10] Chu SY, Callaghan WM, Kim SY et al (2007) Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 30(8):2070–2076. https://doi.org/10.2337/dc06-2559a - DOI - PubMed

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BMI and risk of gestational diabetes among women of South Asian and Chinese ethnicity: a population-based study

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BMI and risk of gestational diabetes among women of South Asian and Chinese ethnicity: a population-based study

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