Ethnic differences translate to inadequacy of high-risk screening for gestational diabetes mellitus in an Asian population: a cohort study

Abstract

BackgroundUniversal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated. Few studies have assessed GDM screening in Asian populations and even fewer have compared Asian ethnic groups in a single multi-ethnic population.Methods1136 pregnant women (56.7% Chinese, 25.5% Malay and 17.8% Indian) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study were screened for GDM by 75-g oral glucose tolerance test (OGTT) at 26–28 weeks of gestation. GDM was defined using the World Health Organization (WHO) criteria. High-risk screening is based on the guidelines of the UK National Institute for Health and Clinical Excellence.ResultsUniversal screening detected significantly more cases than high-risk screening [crude OR 2.2 (95% CI 1.7-2.8)], particularly for Chinese women [crude OR = 3.5 (95% CI 2.5-5.0)]. Pre-pregnancy BMI > 30 kg/m2 (adjusted OR = 3.4, 95% CI 1.5-7.9) and previous GDM history (adjusted OR = 6.6, 95% CI 1.2-37.3) were associated with increased risk of GDM in Malay women while GDM history was the only significant risk factor for GDM in Chinese women (adjusted OR = 4.7, 95% CI 2.0-11.0).ConclusionRisk factors used in high-risk screening do not sufficiently predict GDM risk and failed to detect half the GDM cases in Asian women. Asian women, particularly Chinese, should be screened to avoid under-diagnosis of GDM and thereby optimize maternal and fetal outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-345) contains supplementary material, which is available to authorized users.

Gestational diabetes mellitus and retinal microvasculature

“…We used the 1999 World Health Organization (WHO) criteria to define GDM: ≥7.0 mmol/L for fasting glucose and/or ≥7.8 mmol/L for 2-h post-glucose [14, 15]. Women with GDM were subsequently managed according to standard protocols practiced at both KKH and NUH [14]. …”

Associations of maternal macronutrient intake during pregnancy with infant BMI peak characteristics and childhood BMI1–3

“…At the same visit, information about physical activity, alcohol consumption, and cigarette-smoking habits during pregnancy was collected. Furthermore, an oral-glucose-tolerance test was administered at the same clinic visit; gestational diabetes mellitus was defined on the basis of the 1999 WHO standard criteria (20,21).…”

<i>CAPN10</i> SNP43 G&gt;A gene polymorphism and type 2 diabetes mellitus in the Asian population: a meta-analysis of 9353 participants

“…The significance was not observed in the non-Chinese population, but in the Chinese population, which was probably associated with the different ethnicities in the Asians. Additionally, the ethnicity difference in the demographic and diabetic characteristics might also influence the different results between the Chinese and non-Chinese populations [28][29][30].…”