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Characteristics of Women With Gestational Diabetes From Non-Caucasian Compared With Caucasian Ethnic Groups

  • Stephanie H. Read
    Correspondence
    Address for correspondence: Stephanie H. Read PhD, Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada.
    Affiliations
    Women’s College Research Institute, Women’s College 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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  • 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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  • Julia Lowe
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Sunnybrook Hospital, Toronto, Ontario, Canada
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  • Denice S. Feig
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, 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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  • Lorraine L. Lipscombe
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada

    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
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Published:September 27, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.09.005

      Abstract

      Objectives

      Short- and long-term outcomes in women after gestational diabetes mellitus (GDM) vary by ethnicity. Understanding differences in baseline diabetes risk factors is important for informing choice of risk-reducing interventions. We aimed to compare maternal and pregnancy-related characteristics in Caucasian and non-Caucasian women with GDM.

      Methods

      Using a large multicentre Canadian cohort of women diagnosed with GDM and recruited between 2009 and 2013, we compared demographic, clinical and behavioural characteristics in women with GDM across 7 ethnic groups. Data were obtained from chart reviews and surveys, and logistic and linear regression models were used to compare binary and continuous variables, respectively, between Caucasian and non-Caucasian ethnic groups.

      Results

      Of the 1,332 women with GDM, 911 were eligible for inclusion. Of these, 41.4% were white Caucasian, 17.1% were South Asian, 18.4% were East Asian, 5.8% were black, 8.8% were Filipina, 5.2% were Middle Eastern and 3.3% were Hispanic. Non-Caucasian women were diagnosed with GDM at a younger age and were more likely to have a family history of diabetes compared with Caucasian women. With the exception of East Asians, non-Caucasian women were more likely to be overweight using ethnicity-specific body mass index cutoffs and have higher oral glucose tolerance test values than Caucasian women. Prepregnancy smoking and alcohol consumption prevalence were highest in Caucasian women.

      Conclusions

      Several important ethnicity-specific differences in clinical and behavioural characteristics of women with GDM were identified. These differences need to be considered when offering interventions for reducing risk of adverse perinatal outcomes and subsequent type 2 diabetes.

      Résumé

      Objectifs

      Les issues à court terme et à long terme des femmes ayant eu un diabète sucré gestationnel (DSG) varient selon l’ethnicité. Comprendre les différences dans les facteurs de risques initiaux du diabète est important pour éclairer le choix quant aux interventions visant à réduire les risques. Nous avions pour objectif de comparer les caractéristiques maternelles et celles liées à la grossesse chez des femmes blanches et des femmes non blanches atteintes du DSG.

      Méthodes

      À partir d’une vaste cohorte multicentrique de femmes canadiennes ayant un diagnostic de DSG, et recrutées entre 2009 et 2013, nous avons comparé les caractéristiques démographiques, cliniques et comportementales des femmes atteintes du DSG de 7 groupes ethniques. Nous avons obtenu les données d’une revue de dossiers et d’enquêtes, et avons utilisé des modèles de régression linéaire pour comparer les variables binaires et continues entre les groupes d’origine ethnique blanche et les groupes d’origine ethnique non blanche.

      Résultats

      Parmi les 1332 femmes atteintes du DSG, 911 femmes répondaient aux critères d’inclusion. Parmi ces dernières, 41,4 % étaient des femmes blanches, 17,1 % étaient des femmes de l’Asie du Sud, 18,4 % étaient des femmes de l’Asie de l’Est, 5,8 % étaient des femmes noires, 8,8 % étaient des femmes des Philippines, 5,2 % étaient des femmes du Moyen-Orient et 3,3 % étaient des femmes hispaniques. Les femmes non blanches avaient reçu le diagnostic de DSG à un plus jeune âge et étaient plus susceptibles d’avoir des antécédents familiaux de diabète que les femmes blanches. À l’exception des femmes de l’Asie de l’Est, les femmes non blanches étaient plus susceptibles d’être en surcharge pondérale selon les seuils de l’indice de masse corporelle propre à l’ethnicité et d’avoir des valeurs plus élevées aux épreuves d’hyperglycémie provoquée par voie orale que les femmes blanches. La fréquence de la consommation de tabac et d’alcool avant la grossesse était plus élevée chez les femmes blanches.

      Conclusions

      Nous avons déterminé plusieurs différences importantes propres à l’ethnicité dans les caractéristiques cliniques et comportementales des femmes atteintes du DSG. Il faudra tenir compte de ces différences au moment d’offrir des interventions visant à réduire les risques d’issues périnatales défavorables et d’apparition ultérieure du diabète de type 2.

      Keywords

      Mots clés

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      References

        • Feig D.S.
        • Hwee J.
        • Shah B.R.
        • Booth G.L.
        • Bierman A.S.
        • Lipscombe L.L.
        Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: A large, population-based study in Ontario, Canada, 1996–2010.
        Diabetes Care. 2014; 37: 1590-1596
        • Hedderson M.M.
        • Darbinian J.A.
        • Ferrara A.
        Disparities in the risk of gestational diabetes by race-ethnicity and country of birth.
        Paediatr Perinat Epidemiol. 2010; 24: 441-448
        • Pu J.
        • Zhao B.
        • Wang E.J.
        • et al.
        Racial/ethnic differences in gestational diabetes prevalence and contribution of common risk factors.
        Paediatr Perinat Epidemiol. 2015; 29: 436-443
        • Urquia M.
        • Glazier R.H.
        • Berger H.
        • Ying I.
        • De Souza L.
        • Ray J.G.
        Gestational diabetes among immigrant women.
        Epidemiology. 2011; 22: 879-880
        • Chu S.Y.
        • Abe K.
        • Hall L.R.
        • Kim S.Y.
        • Njoroge T.
        • Qin C.
        Gestational diabetes mellitus: All Asians are not alike.
        Prev Med. 2009; 49: 265-268
        • Yeung R.O.
        • Savu A.
        • Kinniburgh B.
        • et al.
        Prevalence of gestational diabetes among Chinese and South Asians: A Canadian population-based analysis.
        J Diabetes Complic. 2017; 31: 529-536
        • Aljohani N.
        • Rempel B.M.
        • Ludwig S.
        • et al.
        Gestational diabetes in Manitoba during a twenty-year period.
        Clin Invest Med. 2008; 31: E131-E137
        • Bellamy L.
        • Casas J.P.
        • Hingorani A.D.
        • Williams D.
        Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis.
        Lancet. 2009; 373: 1773-1779
        • Langer O.
        • Yogev Y.
        • Most O.
        • Xenakis E.M.
        Gestational diabetes: The consequences of not treating.
        Am J Obstet Gynecol. 2005; 192: 989-997
        • Mukerji G.
        • Chiu M.
        • Shah B.R.
        Gestational diabetes mellitus and pregnancy outcomes among Chinese and South Asian women in Canada.
        J Matern Fetal Neonatal Med. 2013; 26: 279-284
        • Silva J.K.
        • Kaholokula J.K.A.
        • Ratner R.
        • Mau M.
        Ethnic differences in perinatal outcome of gestational diabetes mellitus.
        Diabetes Care. 2006; 29: 2058-2063
        • Cripe S.M.
        • O'Brien W.
        • Gelaye B.
        • Williams M.A.
        Perinatal outcomes of Southeast Asians with pregnancies complicated by gestational diabetes mellitus or preeclampsia.
        J Immigr Minor Health. 2012; 14: 747-753
        • Lipscombe L.L.
        • Banerjee A.T.
        • McTavish S.
        • et al.
        Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: Rationale and study design.
        Diabetes Res Clin Pract. 2014; 106: 57-66
        • R Core Team. R
        A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2018
      1. Statistics Canada. Immigrant languages in Canada. 2016 Census of Population. https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2017025-eng.htm. Accessed October 18, 2019.

        • Hedderson M.
        • Ehrlich S.
        • Sridhar S.
        • Darbinian J.
        • Moore S.
        • Ferrara A.
        Racial/ethnic disparities in the prevalence of gestational diabetes mellitus by BMI.
        Diabetes Care. 2012; 35: 1492-1498
        • Nishikawa E.
        • Oakley L.
        • Seed P.T.
        • Doyle P.
        • Oteng-Ntim E.
        Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK.
        PLoS One. 2017; 12: e0179332
        • Wan C.S.
        • Abell S.
        • Aroni R.
        • Nankervis A.
        • Boyle J.
        • Teede H.
        Ethnic differences in prevalence, risk factors and perinatal outcomes of gestational diabetes mellitus: A comparison between immigrant ethnic Chinese women and Australian-born Caucasian women in Australia.
        J Diabetes. 2019; 11: 809‒17
        • Wong V.W.
        Gestational diabetes mellitus in five ethnic groups: A comparison of their clinical characteristics.
        Diabet Med. 2012; 29: 366-371
        • WHO Expert Consultation
        Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
        Lancet. 2004; 363: 157-163
        • Deurenberg P.
        • Yap M.
        • van Staveren W.A.
        Body mass index and percent body fat: A meta analysis among different ethnic groups.
        Int J Obes Relat Metab Disord. 1998; 22: 1164-1171
        • Yajnik C.S.
        • Yudkin J.S.
        The Y-Y paradox.
        Lancet. 2004; 363: 163
        • WHO Expert Consultation
        Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
        Lancet. 2004; 363: 157-163
        • Rosenberg T.J.
        • Garbers S.
        • Lipkind H.
        • Chiasson M.A.
        Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups.
        Am J Publ Health. 2005; 95: 1545-1551
        • Richardsen K.R.
        • Mdala I.
        • Berntsen S.
        • et al.
        Objectively recorded physical activity in pregnancy and postpartum in a multi-ethnic cohort: Association with access to recreational areas in the neighbourhood.
        Int J Behav Nutr Phys Activity. 2016; 13: 78
        • Ratner R.E.
        • Christophi C.A.
        • Metzger B.E.
        • et al.
        Prevention of diabetes in women with a history of gestational diabetes: Effects of metformin and lifestyle interventions.
        J Clin Endocrinol Metab. 2008; 93: 4774-4779
        • Tobias D.K.
        • Hu F.B.
        • Chavarro J.
        • Rosner B.
        • Mozaffarian D.
        • Zhang C.
        Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus.
        Arch Intern Med. 2012; 172: 1566-1572
        • Chamberlain C.
        • McNamara B.
        • Williams E.D.
        • et al.
        Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States.
        Diabetes Metab Res Rev. 2013; 29: 241-256
        • Harris S.B.
        • Bhattacharyya O.
        • Dyck R.
        • Hayward M.N.
        • Toth E.L.
        Type 2 diabetes in Aboriginal peoples.
        Can J Diabetes. 2013; 37: S191-S196
        • Oster R.T.
        • King M.
        • Morrish D.W.
        • Mayan M.J.
        • Toth E.L.
        Diabetes in pregnancy among First Nations women in Alberta, Canada: A retrospective analysis.
        BMC Pregn Childbirth. 2014; 14: 136
        • Dyck R.
        • Klomp H.
        • Tan L.K.
        • Turnell R.W.
        • Boctor M.A.
        A comparison of rates, risk factors, and outcomes of gestational diabetes between aboriginal and non-aboriginal women in the Saskatoon health district.
        Diabetes Care. 2002; 25: 487-493
        • Harris S.B.
        • Caulfield L.E.
        • Sugamori M.E.
        • Whalen E.A.
        • Henning B.
        The epidemiology of diabetes in pregnant Native Canadians. A risk profile.
        Diabetes Care. 1997; 20: 1422-1425