The Association between Body Mass Index and Gestational Diabetes Mellitus Varies by Race/Ethnicity

ABSTRACT

We examined body mass index (BMI) as a screening tool for gestational diabetes (GDM) and its sensitivity among different racial/ethnic groups. In a retrospective cohort study of 24,324 pregnant women at University of California, San Francisco, BMI was explored as a screening tool for GDM and was stratified by race/ethnicity. Sensitivity and specificity were examined using chi-square test and receiver-operator characteristic curves. BMI of ≥25.0 kg/m² as a screening threshold identified GDM in >76% of African-Americans, 58% of Latinas, and 46% of Caucasians, but only 25% of Asians (p < 0.001). Controlling for confounders and comparing to a BMI of ≤25, African-Americans had the greatest increased risk of GDM (adjusted odds ratio [AOR] 5.1, 95% confidence interval [CI]: 3.0 to 8.5), followed by Caucasians (AOR 3.6, 95% CI: 2.7 to 4.8), Latinas (AOR 2.7, 95% CI: 1.9 to 3.8), and Asians (AOR 2.3, 95% CI: 1.8 to 3.0). BMI's screening characteristics to predict GDM varied by race/ethnicity. BMI can be used to counsel regarding the risk of developing GDM, but alone it is not a good screening tool.

Body mass index - gestational diabetes mellitus - glucose loading test - race/ethnicity - receiver-operator characteristic curve

REFERENCES

• 1 Hollander M H, Paarlberg K M, Huisjes A J. Gestational diabetes: a review of the current literature and guidelines.  Obstet Gynecol Surv. 2007;  62 125-136
• 2 Willman S P, Leveno K J, Guzick D S, Williams M L, Whalley P J. Glucose threshold for macrosomia in pregnancy complicated by diabetes.  Am J Obstet Gynecol. 1986;  154 470-475
• 3 Naylor C D, Sermer M, Chen E, Sykora K. Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators.  JAMA. 1996;  275 1165-1170
• 4 Casey B M, Lucas M J, Mcintire D D, Leveno K J. Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population.  Obstet Gynecol. 1997;  90 869-873
• 5 Bryson C L, Ioannou G N, Rulyak S J, Critchlow C. Association between gestational diabetes and pregnancy-induced hypertension.  Am J Epidemiol. 2003;  158 1148-1153
• 6 Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes.  Diabet Med. 2004;  21 103-113
• 7 Yogev Y, Visser G H. Obesity, gestational diabetes and pregnancy outcome.  Semin Fetal Neonatal Med. 2009;  14 77-84
• 8 Agrawal R K, Lui K, Gupta J M. Neonatal hypoglycaemia in infants of diabetic mothers.  J Paediatr Child Health. 2000;  36 354-356
• 9 Barnes-Powell L L. Infants of diabetic mothers: the effects of hyperglycemia on the fetus and neonate.  Neonatal Netw. 2007;  26 283-290
• 10 Jones C W. Gestational diabetes and its impact on the neonate.  Neonatal Netw. 2001;  20 17-23
• 11 Crowther C A, Hiller J E, Moss J R, McPhee A J, Jeffries W S, Robinson J S. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group . Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.  N Engl J Med. 2005;  352 2477-2486
• 12 Landon M B, Spong C Y, Thom E Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network et al. A multicenter, randomized trial of treatment for mild gestational diabetes.  N Engl J Med. 2009;  361 1339-1348
• 13 Gabbe S G, Gregory R P, Power M L, Williams S B, Schulkin J. Management of diabetes mellitus by obstetrician-gynecologists.  Obstet Gynecol. 2004;  103 1229-1234
• 14 American College of Obstetricians and Gynecologists Committee on Practice Bulletins--Obstetrics . ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes.  Obstet Gynecol. 2001;  98 525-538
• 15 Esakoff T F, Cheng Y W, Caughey A B. Screening for gestational diabetes: different cut-offs for different ethnicities?.  Am J Obstet Gynecol. 2005;  193 (3 Pt 2) 1040-1044
• 16 Ogonowski J, Miazgowski T, Homa K, Celewicz Z, Kuczynska M. Low predictive value of traditional risk factors in identifying women at risk for gestational diabetes.  Acta Obstet Gynecol Scand. 2007;  July 2 (Epub ahead of print)
• 17 Naylor C D, Sermer M, Chen E, Farine D. Toronto Trihospital Gestational Diabetes Project Investigators . Selective screening for gestational diabetes mellitus.  N Engl J Med. 1997;  337 1591-1596
• 18 Wilkins-Haug L, Horton J A, Cruess D F, Frigoletto F D. Antepartum screening in the office-based practice: findings from the collaborative Ambulatory Research Network.  Obstet Gynecol. 1996;  88 (4 Pt 1) 483-489
• 19 U.S. Preventive Services Task Force . Screening for gestational diabetes mellitus: recommendations and rationale.  Obstet Gynecol. 2003;  101 393-395
• 20 Ramos G A, Caughey A B. The interrelationship between ethnicity and obesity on obstetric outcomes.  Am J Obstet Gynecol. 2005;  193 (3 Pt 2) 1089-1093
• 21 Steinfeld J D, Valentine S, Lerer T, Ingardia C J, Wax J R, Curry S L. Obesity-related complications of pregnancy vary by race.  J Matern Fetal Med. 2000;  9 238-241
• 22 Gunton J E, Hitchman R, McElduff A. Effects of ethnicity on glucose tolerance, insulin resistance and beta cell function in 223 women with an abnormal glucose challenge test during pregnancy.  Aust N Z J Obstet Gynaecol. 2001;  41 182-186
• 23 Pi-Sunyer F X. The epidemiology of central fat distribution in relation to disease.  Nutr Rev. 2004;  62 448
• 24 Kousta E, Lawrence N J, Godsland I F et al.. Early metabolic defects following gestational diabetes in three ethnic groups of anti-GAD antibodies negative women with normal fasting glucose.  Hormones (Athens). 2007;  6 138-147
• 25 Rao A K, Cheng Y W, Caughey A B. Perinatal complications among different Asian-American subgroups.  Am J Obstet Gynecol. 2006;  194 e39-e41