1. 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

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

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

4. 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

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

6. 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: > 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)

7. 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.

8. 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

9. Gestational Diabetes: 11 studies
Prevalence
AAPI: %
Hispanics: %
Whites: %
Blacks: %

10. 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

11. 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.

12. 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).

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

14. Impact of these findings…and what we can we do

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

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

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

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

19. 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

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

21. Eat Less, Move More
THANK YOU