Association of Prepregnancy Cardiometabolic Factors With Gestational Diabetes Among Asian Populations in the United States

Abstract

BackgroundAsian individuals are among the highest immigrant group to the United States and at particularly high risk of gestational diabetes, which is associated with long-term maternal cardiovascular disease. Limited data are available on the association of prepregnancy cardiometabolic risk factors with gestational diabetes among Asian American subjects. ObjectivesThis study sought to determine the association of prepregnancy hypertension and body mass index (BMI) among Asian ancestry subgroups and by maternal nativity. MethodsUsing data from the National Vital Statistics System from 2016 to 2019, the prevalence of gestational diabetes, stratified according to prepregnancy hypertension and obesity, was examined according to maternal race. Predicted probability of gestational diabetes with continuous BMI was calculated across Asian ancestry subgroups and by maternal nativity. ResultsAmong 13.3 million pregnancies, gestational diabetes occurred in 6.5%. Asian subjects had the highest prevalence (12.3%). Among those with prepregnancy hypertension, Asian subjects had the highest prevalence (29.3%). Across the range of BMI (18-42 kg/m2), Asian subjects had the highest predicted probability. There was substantial heterogeneity across Asian ancestry subgroups between the association of BMI with gestational diabetes, with highest probability among Japanese and Korean American subjects at BMI >23 kg/m2. Predicted probability of gestational diabetes was higher for mothers born outside the United States among all Asian subgroups, except for Japanese American subjects. ConclusionsAsian American individuals have the highest prevalence of gestational diabetes at any BMI and with hypertension. Substantial variation in risk is present across Asian subgroups. Findings suggest a need for more tailored screening and intervention for gestational diabetes among Asian American subjects, with a specific focus on risk for individuals born outside the United States.