A comparison of South Asian specific and established BMI thresholds for determining obesity prevalence in pregnancy and predicting pregnancy complications: findings from the Born in Bradford cohort

Bryant, Maria; Santorelli, Gillian; Lawlor, Debbie A.; Farrar, Diane; Tuffnell, Derek; Bhopal, Raj; Wright, John

doi:10.1038/ijo.2013.117

Cited by 25 publications

(35 citation statements)

References 16 publications

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“…Ethnicity was also associated with diabetes; after adjustment, South and East Asian women had three times higher odds of diabetes in pregnancy compared to White women. This finding is consistent with previous studies[8, 13, 16–19], many of which have also suggested that obesity affects GDM risk differently by ethnicity, with an increased risk in South and/or East Asian women specifically[8, 13, 14, 16, 17, 20]. We found some evidence that the association between obesity and diabetes risk varied by ethnicity when BMI was used as a categorical variable (p value for interaction 0.043), but there was little evidence of interaction when BMI was modelled as continuous with a quadratic term.…”

Section: Discussionsupporting

confidence: 94%

Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK

et al. 2017

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ObjectiveTo investigate the ethnicity-specific association between body mass index (BMI) and diabetes in pregnancy, with a focus on the appropriateness of using BMI cut-offs to identify pregnant women at risk of diabetes.Study designAnalysis of routinely-collected data from a maternity unit in London, UK. Data were available on 53 264 women delivering between 2004 and 2012. Logistic regression was used to explore the association between diabetes in pregnancy and BMI among women of different ethnicities, and adjusted probability estimates were used to derive risk equivalent cut-offs. ROC curve analysis was used to assess the performance of BMI as a predictor of diabetes in pregnancy.ResultsThe prevalence of diabetes in pregnancy was 2.3% overall; highest in South and East Asian women (4.6% and 3.7%). In adjusted analysis, BMI category was strongly associated with diabetes in all ethnic groups. Modelled as a continuous variable with a quadratic term, BMI was an acceptable predictor of diabetes according to ROC curve analysis. Applying a BMI cut-off of 30 kg/m2 would identify just over half of Black women with diabetes in pregnancy, a third of White (32%) and South Asian (35%) women, but only 13% of East Asian women. The ‘risk equivalent’ (comparable to 30 kg/m2 in White women) threshold for South Asian and East Asian women was approximately 21 kg/m2, and 27.5 kg/m2 for Black women.ConclusionsThis study suggests that current BMI thresholds are likely to be ineffective for diabetes screening in South and East Asian women, as many cases of diabetes will occur at low BMI levels. Our results suggest that East Asian women appear to face a similarly high risk of diabetes to South Asian women. Current UK guidelines recommend diabetes screening should be offered to all pregnant South Asian women; extending this recommendation to include women of East Asian ethnicity may be appropriate.

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Section: Discussionsupporting

confidence: 94%

Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK

et al. 2017

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“…The prevalence of HDP in Africa obtained in this review (10.0%) exceeds the global estimates (5.2%-8.2%) described in a recent report. 5 Additionally, this prevalence seems to be higher than that observed in the United States (6%-8%) 24,25 ; in the UK (5.4%-6.7%), 5,26 and in Australia (8.2%). 5,27 Many factors could explain these differences.…”

Section: Subgroup Analysis Of Hdp Prevalence In Africamentioning

confidence: 62%

The burden of hypertensive disorders of pregnancy in Africa: A systematic review and meta‐analysis

Noubiap

Bigna

Nyaga

et al. 2019

J of Clinical Hypertension

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Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal and perinatal morbidity and mortality, especially in resource‐limited settings. Little is known about the magnitude of HDP in Africa. We conducted the first systematic review and meta‐analysis to summarize available data on the prevalence of HDP in Africa. We did a comprehensive literature search to identify review paper published from January 1, 1996, to September 30, 2017, and searched the reference list of retrieved review paper. We used a random‐effects model to estimate the overall and type‐specific prevalence of HDP in Africa. We included 82 studies published between 1997 and 2017 reporting data on a pooled sample of 854 304 women during pregnancy or puerperium. Most studies were hospital‐based, conducted in urban settings across 24 countries. In this population, the overall prevalence of HDP was 100.4‰ (95% CI: 81.4‐121.2). The prevalence was 49.8‰ (95% CI: 32.3‐70.7) for gestational hypertension, 14.7‰ (95% CI: 11.6‐18.2) for chronic hypertension, 9.2‰ (95% CI: 4.2‐16.0) for superimposed preeclampsia, 44.0‰ (95% CI: 36.7‐52.0) for preeclampsia, 22.1‰ (95% CI: 14.8‐30.8) for severe preeclampsia, 14.7‰ (95% CI: 8.1‐23.2) for eclampsia and 2.2‰ (95% CI: 1.2‐3.4) for HELLP syndrome. Prevalence of HDP was significantly higher in Central and Western Africa; there was a consistent tendency of increasing HDP prevalence with income at the country level. In conclusion, the burden of HDP in Africa is high, with about one in 10 pregnancies affected. The higher rate of severe forms of HDP that are associated with significant maternal and perinatal mortality is a major concern in the region.

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“…Thirteen studies reported data for maternal pre‐pregnancy weight, BMI, SFT and serum leptin levels . Nine reported an increased association with GDM for South Asian women compared with White women . Three found a decreased association .…”

Section: Resultsmentioning

confidence: 99%

Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

et al. 2018

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SummaryAimThis systematic review investigates associations between maternal pre‐pregnancy/early‐pregnancy anthropometrics (e.g. weight and body fat), anthropometric change and pregnancy outcomes in South Asian and White women.MethodsTwelve electronic literature databases, reference lists and citations of all included studies were searched. Observational studies published in the English language were included. Descriptive synthesis was used to summarize the evidence base.ResultsTwenty‐two studies met the inclusion criteria (403,609 births [351,856 White and 51,753 South Asian]). Nine were prospective cohort studies, nine were retrospective cohort studies and two were cross‐sectional studies. Results suggested that in South Asian women, maternal pre‐pregnancy/early‐pregnancy anthropometrics were associated with anthropometric change, birthweight, mode of delivery and gestational diabetes mellitus (GDM). Gestational anthropometric change was found to be associated with GDM. There was limited evidence to suggest that there may be associations between maternal pre‐anthropometrics/early anthropometrics and hypertensive disorders, stillbirth, congenital anomalies, post‐natal weight retention and post‐natal impaired glucose tolerance. The evidence suggested a combined effect of pre‐pregnancy/early‐pregnancy anthropometrics and gestational anthropometric change on both GDM and post‐natal weight retention.ConclusionThe increased risk of adverse pregnancy outcomes in South Asian women should be considered in guidelines for weight management before and during pregnancy.

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A comparison of South Asian specific and established BMI thresholds for determining obesity prevalence in pregnancy and predicting pregnancy complications: findings from the Born in Bradford cohort

Cited by 25 publications

References 16 publications

Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK

Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK

The burden of hypertensive disorders of pregnancy in Africa: A systematic review and meta‐analysis

Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

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