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Perinatal Outcomes Among Different Asian Groups With Gestational Diabetes Mellitus in Ontario: A Cohort Study

  • Wilson Kwong
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Joel G. Ray
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    St Michael's Hospital, Toronto, Ontario, Canada
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  • Wei Wu
    Affiliations
    Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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  • Denice S. Feig
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Sinai Health System, Toronto, Ontario, Canada
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  • Julia Lowe
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Sunnybrook Hospital, Toronto, Ontario, Canada
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  • Lorraine L. Lipscombe
    Correspondence
    Address for correspondence: Lorraine L. Lipscombe MD, MSc, Women's College Hospital, Women's College Research Institute, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada.
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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      Abstract

      Objective

      The aim of this study was to determine whether perinatal outcomes differ between Caucasian and Asian subgroups of women with gestational diabetes mellitus (GDM) through use of standard vs ethnicity-specific birthweight curves.

      Methods

      This retrospective cohort study included 537 women with GDM, within the ethnically diverse province of Ontario, Canada. Study outcomes included large-for-gestational-age (LGA) and small-for-gestational-age (SGA) birthweights in newborns of women from prevalent Asian ethnic groups compared with newborns of Caucasian women. Odds ratios were adjusted for maternal age, parity, prepregnancy body mass index, gestational weight gain and insulin use in pregnancy.

      Results

      Of the 537 women participing in the study, 228 (35.8%) were Caucasian, 109 (17.1%) South Asian, 141 (22.1%) East Asian and 59 (9.3%) Filipino. Using standard birthweight curves, compared with Caucasian women, the risk of LGA was lower among South Asian (adjusted odds ratio [aOR], 0.065; 95% confidence interval [CI], 0.01 to 0.49) and East Asian (aOR, 0.36; 95% CI, 0.14 to 0.95) women. The aOR for SGA was notably higher among South Asian women (aOR, 2.96; 95% CI, 1.24 to 7.09). Significant effects were not seen among Filipino women. Use of ethnicity-specific birthweight curves largely attenuated these associations, except for LGA in South Asian mothers (aOR, 0.27; 95% CI, 0.09 to 0.81).

      Conclusion

      South Asian women with GDM are at lower risk of having an LGA newborn, even after accounting for maternal risk factors or the use of an ethnicity-specific birthweight curve.

      Résumé

      Objectif

      Le but de la présente étude était de déterminer si les issues périnatales sont différentes entre les sous-groupes de femmes blanches et de femmes asiatiques ayant un diabète sucré gestationnel (DSG) à l'aide des courbes de poids à la naissance normaux ou spécifiques à l'origine ethnique.

      Méthodes

      La présente étude de cohorte rétrospective regroupait 537 femmes ayant le DSG, de la province multiethnique de l’Ontario, au Canada. Les résultats de l’étude portaient notamment sur le poids élevé pour l’âge gestationnel (PÉAG) et le faible poids pour l’âge gestationnel (FPAG) à la naissance entre les nouveau-nés des femmes des groupes prévalents d'origine ethnique asiatique et les nouveau-nés des femmes blanches. Les rapports de cotes étaient ajustés à l’âge de la mère, à la parité, à l'indice de masse corporelle avant la grossesse, au gain de poids durant la grossesse et à l'utilisation de l'insuline durant la grossesse.

      Résultats

      Parmi les 537 femmes qui participaient à l’étude, 228 (35,8 %) étaient des femmes blanches, 109 (17,1 %), des femmes sud-asiatiques, 141 (22,1 %), des femmes est-asiatiques et 59 (9,3 %), des femmes philippines. Selon les courbes de poids normaux à la naissance, le risque de PÉAG était plus faible chez les femmes sud-asiatiques (rapport de cotes ajusté [RCa], 0,065; intervalle de confiance [IC] à 95 %, de 0,01 à 0,49) et les femmes est-asiatiques (RCa, 0,36; IC à 95 %, de 0,14 à 0,95) que chez les femmes blanches. Le RCa des FPAG était notablement plus élevé chez les femmes sud-asiatiques (RCa, 2,96; IC à 95 %, de 1,24 à 7,09). Aucun effet significatif n'a été observé chez les femmes philippines. L'utilisation de courbes de poids à la naissance spécifiques à l'origine ethnique atténuait en grande partie ces associations, excepté le FPAG chez les mères sud-asiatiques (RCa, 0,27; IC à 95 %, de 0,09 à 0,81).

      Conclusion

      Les femmes sud-asiatiques ayant un DSG sont exposées à un risque plus faible d'avoir des nouveau-nés de FPAG, même si l'on tient compte des facteurs de risque maternels ou de l'utilisation d'une courbe de poids à la naissance spécifique à l'origine ethnique.

      Keywords

      Mots clés

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