A pilot study on the usefulness of body mass index and waist hip ratio as a predictive tool for gestational diabetes in Asian Indians

Abstract

Gestational diabetes mellitus (GDM) is a common public health issue of pregnancy and women who have had GDM are at high risk for developing of diabetes mellitus Type-2. The aim of this study was to find the association between various clinical and biochemical parameters and GDM. One hundred and six consecutive patients who attended the out patient unit of department of gynecology, Kottayam Medical College, were enrolled in the study and followed up through the whole antenatal, intra-partum and post-partum periods to identify the obstetric outcome. We found that the prevalence of GDM was seven times higher in those with higher waist-hip ratio (WHR > 0.85) compared with those having a lower WHR (p < 0.001).Those with higher WHR gained more weight than other group (10.6 kg vs. 8.1 kg; p < 0.001). Obesity (BMI > or =23) and higher WHR were associated with increased risk of gestational diabetes (BMI > or =23: OR = 7.5, CI 95% = (1.61-34.31), p = 0.013; WHR > 0.85: OR = 12.05, CI 95% = (1.82-77.43), p = 0.007). We found that a WHR of 0.849 has the optimal sensitivity and specificity for the prediction of GDM. A waist circumference of 85.5 cm (with sensitivity of 75%, specificity 81.4%) and a BMI of 24.3 kg/m(2) (sensitivity 75%, specificity 86.5%) had the best predictive value. In conclusion, we found that maternal obesity has a strong correlation with obstetric complications. We found WHR is more important risk determinant for GDM in overweight/obese women than women with normal weight/lean.

Gestational diabetes mellitus: All Asians are not alike

“…Based on the 1992-1995 National Health Interview Survey, the percentage of overweight women in Asian American subgroups ranged from 9% among Vietnamese and Chinese women to 25% among Asian Indian women, (Lauderdale and Rathouz, 2000) and Hawaiians and certain other Pacific Islander populations have even higher levels of overweight and obesity (Maskarinec et al, 2006). Second, a number of studies have reported that Asian Indians have particularly high waist-hip ratios (Davis, 2008;Madhavan et al, 2008) and higher body fat percentages at given BMI levels compared with Chinese and Malay Asians (Deurenberg-Yap et al, 2000); this could at least partially explain why Asian Indian women consistently have higher GDM rates than other API subgroups (Savitz et al, 2008;Berkowitz et al, 1992;Rao et al, 2006a). Finally, differences in other indices of body build such as short stature also have been suggested as possible contributors to differences in GDM risk (Anastasiou et al, 1998;Jang et al, 1998).…”

Maternal Anthropometric Indices and Gestational Diabetes

“…However, area under ROC curves were virtually the same (AUC ~0.6) by WC or BMI for discriminating women with GDM, leading the authors to conclude that both measures carry similar clinical information (Wendland et al 2007 ) . Lastly, a pilot study in India found an interaction between WHR and BMI, with WHR being a stronger risk factor among women who are heavier (Madhavan et al 2008 ) . From their analyses using ROC curves, BMI was found to be better than WHR or WC at predicting GDM case status (Madhavan et al 2008 ) .…”

“…Lastly, a pilot study in India found an interaction between WHR and BMI, with WHR being a stronger risk factor among women who are heavier (Madhavan et al 2008 ) . From their analyses using ROC curves, BMI was found to be better than WHR or WC at predicting GDM case status (Madhavan et al 2008 ) . These fi ndings, however, were based on only eight GDM cases.…”

“…However, the fi ndings seem to be confl icting on the subject. Table 126.5 reviews the evidence of the (Zhang et al 1995 ;Branchtein et al 1997 ;Wendland et al 2007 ;Madhavan et al 2008 ;Yeung et al 2009 ) . Of these studies, the CARDIA and NHSII studies investigated these associations using pre-pregnancy measurements and found that larger waist and WHR were signifi cantly associated with increased risk of GDM (Zhang et al 1995 ;Yeung et al 2009 ) .…”

Antropometría como predictor de diabetes gestacional: Estudio de cohorte

“…En cuanto a factores de riesgo antropomé-tricos, sólo se han descrito al IMC y la relación cintura cadera como predictores de DG [5][6][7] . Sin embargo, el índice de masa corporal (IMC) es un indicador que pierde valor en el embarazo al verse alterado por edema y por el mismo componente materno-fetal del embarazo.…”