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

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/m 2 among South Asian women, 23.0 kg/m 2 among Chinese women and 29.5 kg/m 2 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.

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“…The risk of GDM is significantly higher in Asian women, whose BMI was lower than that of women in the general population. In contrast, these were the least likely ethnic group to receive recommended diabetes screening ( 47 – 49 ). In fact, this might explain why our results align with the study of Swanson et al.…”

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“…GDM is a complex disease that is promoted by interactions between multiple genetic and environmental factors [3]. Several studies had found the interactions between ethnicity, age, and pBMI [32,33], genetic and nutritional factors on the risk of GDM [34]. Other studies had con rmed the interactive effects of modi ed risk factors, including diet, physical activity, and psychological well-being on the risk of GDM [35].…”

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“…Ethnicity is a strong predictor of both GDM and Type 2 DM. Recently studies have identified lower BMI thresholds for non-white populations in predicting incidence of GDM and type 2 diabetes (39,40). A Canadian study found the prevalence of GDM exceeded 5% at an estimated BMI of 21.5 kg/m 2 among South Asian women, 23.0 kg/m 2 among Chinese women and 29.5 kg/m 2 among the general population (40).…”

“…Recently studies have identified lower BMI thresholds for non-white populations in predicting incidence of GDM and type 2 diabetes (39,40). A Canadian study found the prevalence of GDM exceeded 5% at an estimated BMI of 21.5 kg/m 2 among South Asian women, 23.0 kg/m 2 among Chinese women and 29.5 kg/m 2 among the general population (40). Similarly, in a populationbased cohort study (1 472 819 people) for the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30.0 kg/m² in White populations, the BMI cutoffs were 23.9 kg/m² (95% CI: 23.6-24.0) in South Asian populations, 28•1 kg/m² (28.0-28.4) in Black populations, 26.9 kg/m² (26.7-27.2) in Chinese populations, and 26.6 kg/m² (26.5-27.0) in Arab populations (39).…”