Public Health Program, Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA.
Department of Public Health, School of Social Sciences Humanities and Arts, Health Science Research Institute, University of California Merced, Merced, California, USA.
Metab Syndr Relat Disord. 2024 Aug;22(6):479-486. doi: 10.1089/met.2023.0269. Epub 2024 Apr 17.
Gestational diabetes mellitus (GDM) complicates ∼10% of pregnancies, with the highest rates among Asian women. Evidence suggests that GDM is associated with an increased risk for future chronic health conditions, yet data for Asian women are sparse. We explored the association between prior GDM and metabolic dysfunction with nationally representative data to obtain Asian-specific estimates. For this cross-sectional study, data were drawn from the National Health and Nutrition Examination Survey for 7195 women with a prior pregnancy. GDM (yes/no) was defined using the question "During pregnancy, were you ever told by a doctor or other health professional that you had diabetes, sugar diabetes, or gestational diabetes?." Current metabolic dysfunction (yes/no) was based on having at least one of four indicators: systolic blood pressure (SBP, ≥130 mmHg), waist circumference (≥88 cm), high-density lipoprotein (HDL) cholesterol (<50 mg/dL), and glycosylated hemoglobin (HbA1c) (≥6.5%). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between prior GDM and metabolic outcomes, overall and by race. Models included sampling weights and demographic and behavioral factors. Overall, women with prior GDM had 46% greater odds of high waist circumference (OR: 1.5; 95% CI: 1.1-2.0) and 200% greater odds (OR: 3.0; 95% CI: 2.1-4.2) of high HbA1c. Prior GDM was not associated with high blood pressure or low HDL cholesterol. In race-specific analyses, prior GDM was associated with increased risk of elevated HbA1c among Asian (OR: 6.6; 95% CI: 2.5-17.2), Mexican American (OR: 3.0; 95% CI: 1.5-5.8), Black (OR: 3.0; 95% CI: 1.7-5.5), and White (OR: 2.6; 95% CI: 1.5-4.6) women. Prior GDM was associated with elevated SBP among Mexican American women and low HDL among Black women. Prior GDM is associated with elevated HbA1c among all women, yet is a stronger predictor of elevated HbA1c among Asian women than other women. Race-specific associations between prior GDM and metabolic dysfunction were observed among Mexican American and Black women. Further research is warranted to understand the observed race/ethnic-specific associations.
妊娠期糖尿病（GDM）会影响约 10%的妊娠，其中亚洲女性的发病率最高。有证据表明，GDM 与未来慢性健康状况的风险增加有关，但亚洲女性的数据很少。我们利用具有全国代表性的数据，通过一项针对既往 GDM 与代谢功能障碍相关性的横断面研究，获得亚洲特有的估计值。 在这项横断面研究中，数据来自于全国健康和营养调查，共纳入了 7195 名有既往妊娠史的女性。既往 GDM（是/否）的定义是通过以下问题：“在怀孕期间，医生或其他健康专家是否告诉过您患有糖尿病、糖糖尿病或妊娠期糖尿病？”。目前的代谢功能障碍（是/否）是基于至少有以下四个指标之一：收缩压（SBP，≥130mmHg）、腰围（≥88cm）、高密度脂蛋白（HDL）胆固醇（<50mg/dL）和糖化血红蛋白（HbA1c）（≥6.5%）。逻辑回归估计了既往 GDM 与代谢结局之间的关联的比值比（OR）和 95%置信区间（CI），总体上以及按种族进行分析。模型包括了抽样权重以及人口统计学和行为因素。 总体而言，有既往 GDM 的女性腰围增大的几率高 46%（OR：1.5；95%CI：1.1-2.0），HbA1c 升高的几率高 200%（OR：3.0；95%CI：2.1-4.2）。既往 GDM 与高血压或低 HDL 胆固醇无关。在按种族进行的分析中，既往 GDM 与亚洲人（OR：6.6；95%CI：2.5-17.2）、墨西哥裔美国人（OR：3.0；95%CI：1.5-5.8）、黑人（OR：3.0；95%CI：1.7-5.5）和白人（OR：2.6；95%CI：1.5-4.6）女性的 HbA1c 升高相关。既往 GDM 与墨西哥裔美国女性的 SBP 升高以及黑人女性的 HDL 降低相关。 既往 GDM 与所有女性的 HbA1c 升高相关，但与其他女性相比，它是亚洲女性 HbA1c 升高的更强预测因素。在墨西哥裔美国人和黑人女性中观察到了既往 GDM 与代谢功能障碍之间的种族特异性关联。需要进一步研究以了解观察到的种族/民族特异性关联。
