Confounding effect of ethnic diversity on booking‐in body mass index and prevalence of gestational diabetes and hypertensive disorders in pregnant women in western Sydney 1997–2016

Abstract

Background: Maternal obesity is a key risk factor for morbidity in pregnancy.Accurate data on trends in obesity are required in high-risk populations such as in western Sydney to implement effective policy.Results: There were 112 308 pregnant women included. Between 1997 and 2006, mean booking-in BMI climbed from 24.9 (median 23.9) to peak at 26.2 (24.9). It then fell to 25.3 (24.1) in 2012 before rising to 25.6 (24.4) in 2016. Rates of hypertensive disorders changed little over the period, with a small fall in pre-eclampsia.In contrast, there was a progressive upward trend in the prevalence of GDM, accelerating considerably after 2010. These trends were associated with a shifting ethnic profile with proportions of Australia/New Zealand-born women falling from 56.9% to 36.8%, while those from South Asia increased from 4.5% to 26.3%. Conclusions:Western Sydney booking-in BMI fluctuated between 1997 and 2016, reaching its peak in 2006. Despite this, rates of GDM progressively rose, with one in six mothers in western Sydney now diagnosed with some form of the condition.Both patterns are associated with a notable shift in the ethnic profile of patients booking-in to antenatal care in the region. K E Y W O R D Sepidemiology, gestational diabetes, hypertensive disorders, obesity, pre-eclampsia, pregnancyAustralian-born women). In our study, GDM now affects almost one in four South Asian women in western Sydney. In comparison, epidemiological studies in India and other SouthAsian countries demonstrate prevalence of GDM of up to 17.8% of women. 23 The greater frequency in our findings may be accounted for by compounding this inherent risk with the western lifestyle.South Asian cultural attitudes to diet and activity in pregnancy can limit the effectiveness of interventions to reduce GDM. 24,25 Since South Asian women are at high risk of developing type 2 diabetes long-term 26 identifying culturally appropriate approaches to reduce GDM may prevent long-term morbidity for both women and their offspring. 27 Ethnicity and gestational hypertensionOur stable rates of hypertensive disorders contrast with other Australian studies showing a decline over the same period, which those authors speculate may be due to elective delivery prior to the due date, and the use of interventions such low-dose aspirin and calcium supplementation. 28,29 There were no changes in local policy regarding the diagnosis or treatment of hypertensive conditions during the study period.Our lack of a decline is despite the reported protective nature of Asian ethnicity 30 and may reflect the fact that, in our study, country of birth showed no correlation with rates of chronic and gestational hypertension, and pre-eclampsia. Changes in GDM criteria during the study periodIt is important to note that GDM diagnostic criteria did not change across the three sites during the study period, despite domestic and global changes in standards. On a national level, the 'new' ADIPS criteria 31 replaced the 'old' ADIPS criteria in late 2014 following the lead of Interna...

Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

“…GDM is defined as meeting the above 75 g OGTT diagnostic criteria at any time during pregnancy, and the upper limit levels of fasting and 2-h blood glucose were defined (11). With the increasing prevalence of obesity and changes in people's lifestyle, the prevalence of GDM has also significantly increased two to three times in ∼10 years (12)(13)(14). The prevalence rate of GDM in the Middle East and some North African countries has reached 15.2% (2), while that of Chinese mainland is 14.8% (15).…”

Reporting of gestational diabetes and other maternal medical conditions

“…Consistency of reporting was similar for the two hospitals, suggesting that the results hold across different socioeconomic and ethnic patient populations, locations, and facilities. Slight differences in the rates may reflect the different demographic compositions, with Hospital One tending to have an older obstetric population with a different mix of ethnicities and comorbidities [ 36 ].…”

The relationship between offspring's 2D:4D ratio and postpartum maternal circulating testosterone, estradiol, and their indices in a Ghanaian population

“…Also, the outcome of studies among women with diabetes mellitus regarding SRB were mixed. It was explained that excess adrenal hormones may stimulate the release of glucose in stressful conditions and the adrenal hormones and not the glucose may be the determining factor of the high SRB (Brown et al, 2020). Although the hormonal hypothesis has some credibility, some have critiqued that it is only supported by correlational or observational but not experimental evidence (James & Grech, 2017).…”