Sperling Meryl M, Leonard Stephanie A, Blumenfeld Yair J, Carmichael Suzan L, Chueh Jane
Departments of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Drs Sperling, Leonard, Blumenfeld, Carmichael, and Chueh).
Pediatrics (Dr Carmichael), Stanford University School of Medicine, Stanford, CA.
AJOG Glob Rep. 2022 Dec 16;3(1):100148. doi: 10.1016/j.xagr.2022.100148. eCollection 2023 Feb.
The American College of Obstetricians and Gynecologists recommends early screening for gestational diabetes mellitus among pregnant Asian people with a prepregnancy body mass index ≥23.0 kg/m, in contrast with the recommended screening at a body mass index ≥25 kg/m for other races and ethnicities. However, there is significant heterogeneity within Asian and Pacific Islander populations, and gestational diabetes mellitus and its association with body mass index among Asian and Pacific Islander subgroups may not be uniform across all groups.
This study aimed to analyze the association between body mass index and gestational diabetes mellitus among Asian and Pacific Islander subgroups in California, specifically gestational diabetes mellitus rates among those with a body mass index above vs below 23 kg/m, which is the cutoff point for the designation of being overweight among Asians populations.
Using a linked delivery hospitalization discharge and vital records database, we identified patients who gave birth in California between 2007 and 2017 and who self-reported to be 1 of 13 Asian and Pacific Islander subgroups, which was collected from birth and fetal death certificates. In each subgroup, we evaluated the association between body mass index and gestational diabetes mellitus using multivariable logistic regression models adjusted for age, education, parity, payment method, the trimester in which prenatal care was initiated, and nativity. We fit body mass index nonlinearly with splines and categorized body mass index as being above or below 23 kg/m. Predicted probabilities of gestational diabetes mellitus with 95% confidence intervals were calculated across body mass index values using the nonlinear regression models.
The overall prevalence of gestational diabetes mellitus was 14.3% (83,400/584,032), ranging between 8.4% and 17.1% across subgroups. The highest prevalence was among Indian (17.1%), Filipino (16.7%), and Vietnamese (15.5%) subgroups. In these subgroups, gestational diabetes mellitus was diagnosed in 10% to 13% of those with a body mass index <23.0 kg/m and in 22% of those with a body mass index ≥23 kg/m. Gestational diabetes mellitus was least common among Korean (8.4%), Japanese (9.0%), and Samoan (9.8%) subgroups with a gestational diabetes mellitus rate of 5% to 7% among those with a body mass index <23.0 kg/m and in 10% to 15% among those with a body mass index ≥23 kg/m. Although Samoan patients had the highest rate of obesity, defined as body mass index ≥30 kg/m (57.4%), they had the third lowest prevalence of gestational diabetes mellitus. Conversely, Vietnamese patients had the second lowest rate of obesity (2.4%) but the highest rate of gestational diabetes mellitus at a body mass index of ≥23 kg/m (22.3%).
Gestational diabetes mellitus and its association with body mass index varied among Asian subgroups but increased as body mass index increased. Subgroups with the lowest prevalence of obesity trended toward a higher prevalence of gestational diabetes mellitus and those with a higher prevalence of obesity trended toward a lower prevalence of gestational diabetes mellitus.
美国妇产科医师学会建议，对于孕前体重指数≥23.0kg/m²的亚洲孕妇，应尽早进行妊娠期糖尿病筛查，这与针对其他种族和族裔建议的体重指数≥25kg/m²时进行筛查不同。然而，亚洲和太平洋岛民群体内部存在显著异质性，亚洲和太平洋岛民亚组中妊娠期糖尿病及其与体重指数的关联在所有群体中可能并不一致。
本研究旨在分析加利福尼亚州亚洲和太平洋岛民亚组中体重指数与妊娠期糖尿病之间的关联，特别是体重指数高于和低于23kg/m²（亚洲人群中超重的临界点）者的妊娠期糖尿病发生率。
利用链接的分娩住院出院和生命记录数据库，我们识别出2007年至2017年间在加利福尼亚州分娩且自我报告为13个亚洲和太平洋岛民亚组之一的患者，这些信息来自出生和胎儿死亡证明。在每个亚组中，我们使用多变量逻辑回归模型评估体重指数与妊娠期糖尿病之间的关联，该模型对年龄、教育程度、产次、支付方式、开始产前护理的孕周和出生地进行了调整。我们用样条函数对体重指数进行非线性拟合，并将体重指数分为高于或低于23kg/m²。使用非线性回归模型计算不同体重指数值下妊娠期糖尿病的预测概率及95%置信区间。
妊娠期糖尿病的总体患病率为14.3%（83400/584032），各亚组患病率在8.4%至17.1%之间。患病率最高的是印度（17.1%）、菲律宾（16.7%）和越南（15.5%）亚组。在这些亚组中，体重指数<23.0kg/m²者中10%至13%被诊断为妊娠期糖尿病，体重指数≥23kg/m²者中22%被诊断为妊娠期糖尿病。妊娠期糖尿病在韩国（8.4%）、日本（9.0%）和萨摩亚（9.8%）亚组中最不常见，体重指数<23.0kg/m²者的妊娠期糖尿病发生率为5%至7%，体重指数≥23kg/m²者为10%至15%。尽管萨摩亚患者肥胖率最高，定义为体重指数≥30kg/m²（57.4%），但其妊娠期糖尿病患病率却是第三低。相反，越南患者肥胖率第二低（2.4%），但在体重指数≥23kg/m²时妊娠期糖尿病发生率最高（22.3%）。
妊娠期糖尿病及其与体重指数的关联在亚洲亚组中各不相同，但随着体重指数的增加而升高。肥胖患病率最低的亚组妊娠期糖尿病患病率往往较高，而肥胖患病率较高的亚组妊娠期糖尿病患病率往往较低。
