Tam H. Nguyen, PhD, MSN/MPH, RN Gestational diabetes among Asian American women: A paradox in disease burden Tam H. Nguyen, PhD, MSN/MPH, RN

Objectives Provide a brief overview of Gestational DM Discuss the prevalence (burden of disease) of GDM among Asian Americans Provide some rationales & solutions

Gestational DM Definition: Glucose intolerance with onset or 1st recognition during pregnancy (ADA, 2006)

Complications related to GDM Maternal Increased risk of: Caesarean birth Vaginal tearing Hypertensive disorders DM later life Infant Increased risk of Macrosomia (Being large for gestational age) Shoulder dystocia Birth trauma Childhood obesity DM later in life Preeclampsia = hypertensive disorders

So how big of a burden is GDM among Asian Americans? …. A paradox in disease burden

Prevalence of GDM among Asian Americans & Problems with data GDM diagnostic criteria Carpenter & Coustan National Diabetes Data Group International Association of Diabetes and Pregnancy Study Groups (IADPSG) 50g Oral glucose loading test At 24 to 28 weeks GDM: >130-140 mg/dL 100g Diagnostic Oral glucose loading test GDM: > Studies do not always report population level data There is lack of consensus regarding diagnostic tests and cut-off values Different sources data (birth records vs. hosp. discharge info) result in biased findings. Therefore, we conducted systematic review of the prevalence of GDM among AAPIs using population based studies “Prevalence is sensitive to the diagnostic criteria. There are three primary criteria used in the US: Carpenter & Coustan diagnostic criteria vs. National Diabetes Data Group vs. International Association of Diabetes and Pregnancy Study Groups (IADPSG) . The 1st two are recommended by ACOG, while the second is recommended by the ADA (however NIH concludes that there is insufficient data to support IADPSG)” (Ferrara et al, 2002; DeSisto et al, 2014)

Systematic review of GDM prevalence among Asian Americans Only studies that employed some type of population-based sampling strategy were included (n=13) given the bias in prevalence rates that can occur with convenient samples.

Findings (n= 14 studies) Sample Size: n = 3,779 to 3,108,877 4 were from national databases, 6 were from single state 4 were from single hospital records

Gestational Diabetes: 11 studies Prevalence AAPI: 3.9 - 16.3% Hispanics: 3.1 - 12.1% Whites: 2.2 - 6.8% Blacks: 1.7 - 10.5%

GDM by Asian American subgroup 6 of the 14 studies provided disaggregated data But not all in the same way That data suggests that Asian Indians and Pacific Islanders had the highest rates of GDM

GDM among Asian American by BMI 4 studies reported baseline BMI data When examining GDM prevalence by BMI, AAPIs had high rates of GDM across all BMI categories. In comparison, other ethnic groups consistently had low rates of GDM at lower BMI categories, with increasing rates of GDM as BMI increased.

Possible reasons for increased risk of DM despite lower BMI “Thrifty gene” hypothesis This hypothesis proposes that this diabetic genotypes may confer a survival advantage during times of famine by maximizing excess food energy but increase risk for obesity and diabetes during times of long-term food abundance (Groop and Orho-Melander, 2001).

Possible reasons for increased risk of DM despite lower BMI Differences in body composition

Impact of these findings…and what we can we do

Impact Rising GDM may influence future disparities in DM among Asian Americans Increase the risk of OBESITY among Asian American children

Things we can do… Break the silence.., share this knowledge

Things we can do… Prompt screening and TIGHT metabolic control during & after pregnancy is imperative! Unique opportunity for population based genome studies

What does “TIGHT” control mean? Keeping your glucose level as close to normal as possible 70-130 mg/dL before meals Less than 180 mg/dL after meals Meal planning & regularly checking blood sugar

Preventing GDM Control your weight (& your waist) Increase physical fitness Increase sleep & sleep quality Tune up your diet Choose whole grains, fruits and vegetables over processed foods Decrease risk by 20% Skip sugary drinks

Preventing GDM Choose good fats over bad fats Limit red meat & processed meat If you smoke, try to quit Avoid stress

Eat Less, Move More THANK YOU tam.nguyen@bc.edu