Gestational diabetes and macrosomia by race/ethnicity in Hawaii

Pai-Jong Stacy Tsai,Timothy Dye,Emily Roberson

doi:10.1186/1756-0500-6-395

Pai-Jong Stacy Tsai, Timothy Dye + Show 1 more

Open Access

https://doi.org/10.1186/1756-0500-6-395

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Abstract

BackgroundGestational diabetes (GDM) has been shown to have long-term sequelae for both the mother and infant. Women with GDM are at increased risk of macrosomia, which predisposes the infant to birth injuries. Previous studies noted increased rates of GDM in Asian and Pacific Islander (API) women; however, the rate of macrosomia in API women with GDM is unclear. The objective of this study was to examine the relationship between ethnicity, gestational diabetes (GDM), and macrosomia in Hawaii.MethodsA retrospective cohort study was performed using Hawaii Pregnancy Risk Assessment Monitoring System (PRAMS) data. Data from 2009–2011, linked with selected items from birth certificates, were used to examine GDM and macrosomia by ethnicity. SAS-callable SUDAAN 10.0 was used to generate odds ratios, point estimates and standard errors.ResultsData from 4735 respondents were weighted to represent all pregnancies resulting in live births in Hawaii from 2009–2011. The overall prevalence of GDM in Hawaii was 10.9%. The highest prevalence of GDM was in Filipina (13.1%) and Hawaiian/Pacific Islander (12.1%) women. The lowest prevalence was in white women (7.4%). Hawaiian/Pacific Islander, Filipina, and other Asian women all had an increased risk of GDM compared to white women using bivariate analysis. Adjusting for obesity, age, maternal nativity, and smoking, Asian Pacific Islander (API) women, which includes Hawaiian/Pacific Islander, Filipina, and other Asian women, had a 50% increased odds of having GDM compared to white women when compared using multivariate analysis. Among women with GDM, the highest prevalence of macrosomia was in white women (14.5%) while the lowest was in Filipina (5.3%) women.ConclusionsAPI women in Hawaii have increased rates of GDM compared to white women. Paradoxically, this elevated GDM risk in API women is not associated with an increased rate of macrosomia. This suggests the relationship between GDM and macrosomia is more complex in this population.

Highlights

Gestational diabetes (GDM) has been shown to have long-term sequelae for both the mother and infant
Among women with GDM, the highest prevalence of macrosomia was in white women (14.5%) while the lowest was in Filipina women (5.3%)
If the glucose loading test (GLT) test is above a certain threshold level, patients are referred for a three-hour 100-gram glucose tolerance test (GTT)

Summary

Introduction

Gestational diabetes (GDM) has been shown to have long-term sequelae for both the mother and infant. A retrospective cohort study using birth certificate data in California noted GDM prevalence to be 10% among Asian women, higher than white (4.6%), Black (4.5%), and Hispanic (6.9%). Another study using birth certificate data in the U.S showed API women had a substantially higher age-adjusted prevalence of GDM (6.3%) compared to white (3.8%), Black (3.5%), or Hispanic (3.6%) women. They noted significant differences among API subgroups, ranging from 3.7% in Japanese women to 8.6% in Asian Indian women [16]. Using birth certificate data in New York, Chinese and non-Chinese East Asian/Pacific Islander women were found to have increased odds of GDM, OR 1.9 (95% CI 1.82.1) and 1.7 (95% CI 1.5-1.8), respectively, compared to white women [18]

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