Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study

Abstract

ObjectiveThe International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently proposed new criteria for diagnosing gestational diabetes mellitus (GDM). We compared prevalence rates, risk factors, and the effect of ethnicity using the World Health Organization (WHO) and modified IADPSG criteria.MethodsThis was a population-based cohort study of 823 (74% of eligible) healthy pregnant women, of whom 59% were from ethnic minorities. Universal screening was performed at 28±2 weeks of gestation with the 75 g oral glucose tolerance test (OGTT). Venous plasma glucose (PG) was measured on site. GDM was diagnosed as per the definition of WHO criteria as fasting PG (FPG) ≥7.0 or 2-h PG ≥7.8 mmol/l; and as per the modified IADPSG criteria as FPG ≥5.1 or 2-h PG ≥8.5 mmol/l.ResultsOGTT was performed in 759 women. Crude GDM prevalence was 13.0% with WHO (Western Europeans 11%, ethnic minorities 15%, P=0.14) and 31.5% with modified IADPSG criteria (Western Europeans 24%, ethnic minorities 37%, P< 0.001). Using the WHO criteria, ethnic minority origin was an independent predictor (South Asians, odds ratio (OR) 2.24 (95% confidence interval (CI) 1.26–3.97); Middle Easterners, OR 2.13 (1.12–4.08)) after adjustments for age, parity, and prepregnant body mass index (BMI). This increased OR was unapparent after further adjustments for body height (proxy for early life socioeconomic status), education and family history of diabetes. Using the modified IADPSG criteria, prepregnant BMI (1.09 (1.05–1.13)) and ethnic minority origin (South Asians, 2.54 (1.56–4.13)) were independent predictors, while education, body height and family history had little impact.ConclusionGDM prevalence was overall 2.4-times higher with the modified IADPSG criteria compared with the WHO criteria. The new criteria identified many subjects with a relatively mild increase in FPG, strongly associated with South Asian origin and prepregnant overweight.

Ethnic differences in BMI, subcutaneous fat, and serum leptin levels during and after pregnancy and risk of gestational diabetes

“…A standard 75 g oral glucose tolerance test (OGTT) was performed at 28 weeks of gestation with fasting and 2-h plasma glucose analyzed on-site in venous EDTA blood samples (HemoCue, Angelholm, Sweden) (4). GDM was defined by the WHO 2013 criteria (23) (fasting glucose R5.1 mmol/l or 2-h glucose R8.5 mmol/l) and 1-h glucose was not available (4).…”

“…South Asian migrants to Europe have a high prevalence of type 2 diabetes (3) and gestational diabetes (GDM) (4). GDM is defined as first recognition of hyperglycemia during pregnancy (5).…”

Failure to increase insulin secretory capacity during pregnancy-induced insulin resistance is associated with ethnicity and gestational diabetes

“…The Regional Ethics committee and The Norwegian Data Inspectorate approved the study protocol. The methods are described in detail elsewhere (9,15). Women were eligible if they: i) lived in the districts; ii) planned to give birth at one of two study hospitals; iii) were at !20 weeks of gestation at visit 1 (V1); iv) could communicate in Norwegian, Arabic, English, Sorani, Somali, Tamil, Turkish, Urdu or Vietnamese; and v) were able to give written consent to participate.…”

“…We recently reported that the prevalence of GDM with both the WHO and the modified IADPSG criteria was high for Western European and immigrant women living in Oslo (9). GDM is increasing in line with the diabetes type 2 prevalence worldwide (12,13).…”

“…Compared with the WHO criteria, the cut-off values in the IADPSG criteria are lowered for fasting plasma glucose (FPG) and raised for 2-h plasma glucose (PG) (5,8). One abnormal glucose value is adequate for the IADPSG GDM diagnosis, and the majority of cases are reported to be identified by the FPG cut-off value (8,9,10). The IADPSG criteria thus identify some women who have not previously been identified with GDM (11).…”