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标题：Fraction of Gestational Diabetes Mellitus Attributable to Overweight and Obesity by Race/Ethnicity, California, 2007–2009
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作者：Shin Y. Kim ; Carina Saraiva ; Michael Curtis 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2013
卷号：103
期号：10
页码：e65-e72
DOI：10.2105/AJPH.2013.301469
语种：English
出版社：American Public Health Association
摘要：Objectives. We calculated the racial/ethnic-specific percentages of gestational diabetes mellitus (GDM) attributable to overweight and obesity. Methods. We analyzed 1 228 265 records of women aged 20 years or older with a live, singleton birth in California during 2007 to 2009. Using logistic regression, we estimated the magnitude of the association between prepregnancy body mass index and GDM and calculated the percentages of GDM attributable to overweight and obesity overall and by race/ethnicity. Results. The overall estimated GDM prevalence ranged from 5.4% among White women to 11.9% among Asian/Pacific Islander women. The adjusted percentages of GDM deliveries attributable to overweight and obesity were 17.8% among Asians/Pacific Islander, 41.2% among White, 44.2% among Hispanic, 51.2% among Black, and 57.8% among American Indian women. Select Asian subgroups, such as Vietnamese (13.0%), Asian Indian (14.0%), and Filipino (14.2%), had the highest GDM prevalence, but the lowest percentage attributable to obesity. Conclusions. Elevated prepregnancy body mass index contributed to GDM in all racial/ethnic groups, which suggests that decreasing overweight and obesity among women of reproductive age could reduce GDM, associated delivery complications, and future risk of diabetes in both the mother and offspring. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance leading to hyperglycemia with onset or first recognition during pregnancy. GDM is associated with increased maternal and infant complications, including infant macrosomia, birth trauma, hypoglycemia, and cesarean section. 1–4 Offspring of mothers with GDM are at increased risk for metabolic syndrome and type 2 diabetes in adulthood. 5 GDM prevalence estimates range from 1% to 14% of all pregnancies in the United States, depending on the population studied and the diagnostic tests employed. 6 Although some women diagnosed with GDM have abnormal glycemia that persists, most women will revert to normal carbohydrate metabolism after delivery. 7 Women with a history of GDM are at increased risk of GDM in future pregnancies, 8 and more than 50% will develop type 2 diabetes later in life. 9 Previous studies have shown that GDM prevalence estimates differ vastly by race/ethnicity. American Indians, Hispanics, and Asians have the highest estimates of GDM, 10,11 and these differences have not been fully explained by prepregnancy body mass index (BMI). 12,13 California is the most populous state in the United States, with an estimated 39.1 million residents in 2010. Its population is diverse, with an estimated 42% White, 37% Hispanic, 12% Asian, 6% Black, 2% multiracial, 0.6% American Indian, and 0.4% Native Hawaiian/Pacific Islander. Recent trends in the racial/ethnic composition of California’s population predicts a continuing decline in the White population and an increase in the Hispanic population through 2020, when Hispanics are projected to become the largest racial/ethnic group in California. 14 In addition, California records more than 500 000 births in a given year, half of which are to Hispanic women. In California, during the next 10 years, births to Black women will likely decrease by almost 4%, and births to Asian, American Indian, and Pacific Islander women will likely increase by 6%, 6%, and 16%, respectively. 8 Hispanic women are expected to have the largest numerical increase in births during the next 10 years. 15 In a recent study of diabetes during pregnancy in California, it was reported that prevalence of maternal diabetes had risen from 4.6% of births in 1999 to 6.5% in 2005, with preexisting diabetes increasing by 28% and GDM increasing by 44%. 16 The authors suggested that the increase in GDM might be attributable to recent increases in overweight and obesity among women of reproductive age. The purpose of the present study was to estimate the contribution of BMI to GDM risk across different racial/ethnic groups by calculating the race/ethnicity-specific percentages of GDM attributable to prepregnancy overweight and obesity among women giving birth in California during 2007 to 2009.