Association of Prepregnancy Cardiometabolic Factors With Gestational Diabetes Among Asian Populations in the United States

Theresa Boyer; Christine Hsueh; Kevin Sun; Yaa Adoma Kwapong; Arthur Jason Vaught; Justin Echouffo Tcheugui; Elizabeth Selvin; Chiadi E Ndumele; Allison G Hays; Erin D Michos; Josef Coresh; Anum S Minhas

doi:10.1016/j.jacasi.2024.07.010

Association of Prepregnancy Cardiometabolic Factors With Gestational Diabetes Among Asian Populations in the United States

JACC Asia. 2024 Sep 24;4(11):842-852. doi: 10.1016/j.jacasi.2024.07.010. eCollection 2024 Nov.

Authors

Theresa Boyer¹, Christine Hsueh², Kevin Sun³, Yaa Adoma Kwapong³, Arthur Jason Vaught⁴, Justin Echouffo Tcheugui⁵, Elizabeth Selvin¹, Chiadi E Ndumele^{1

6}, Allison G Hays^{3

6}, Erin D Michos^{3

6}, Josef Coresh^{7

8}, Anum S Minhas^{3

6}

Affiliations

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
² Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA.
³ Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴ Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins University, Baltimore, Maryland, USA.
⁵ Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁶ Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁷ Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.
⁸ Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.

Abstract

Background: Asian individuals are among the highest immigrant group to the United States and at particularly high risk of gestational diabetes, which is associated with long-term maternal cardiovascular disease. Limited data are available on the association of prepregnancy cardiometabolic risk factors with gestational diabetes among Asian American subjects.

Objectives: This study sought to determine the association of prepregnancy hypertension and body mass index (BMI) among Asian ancestry subgroups and by maternal nativity.

Methods: Using data from the National Vital Statistics System from 2016 to 2019, the prevalence of gestational diabetes, stratified according to prepregnancy hypertension and obesity, was examined according to maternal race. Predicted probability of gestational diabetes with continuous BMI was calculated across Asian ancestry subgroups and by maternal nativity.

Results: Among 13.3 million pregnancies, gestational diabetes occurred in 6.5%. Asian subjects had the highest prevalence (12.3%). Among those with prepregnancy hypertension, Asian subjects had the highest prevalence (29.3%). Across the range of BMI (18-42 kg/m²), Asian subjects had the highest predicted probability. There was substantial heterogeneity across Asian ancestry subgroups between the association of BMI with gestational diabetes, with highest probability among Japanese and Korean American subjects at BMI >23 kg/m². Predicted probability of gestational diabetes was higher for mothers born outside the United States among all Asian subgroups, except for Japanese American subjects.

Conclusions: Asian American individuals have the highest prevalence of gestational diabetes at any BMI and with hypertension. Substantial variation in risk is present across Asian subgroups. Findings suggest a need for more tailored screening and intervention for gestational diabetes among Asian American subjects, with a specific focus on risk for individuals born outside the United States.

Keywords: cardiometabolic; gestational diabetes; obesity.