Aim: To compare characteristics of women with GDM according to birth-region, in a multi-ethnic clinic.
Method: A retrospective analysis of women attending Blacktown Hospital GDM service from 2002-11. Known Type 1 or 2 diabetes cases were excluded. Data from only one pregnancy per woman was used. Women were grouped into 5 birth-regions for comparison. BGLs during antenatal and postnatal GTT were compared between regions, using Mann-Whitney test. Logistic regression calculated the odds ratio of dysglycaemia, using the West as reference group. Student’s t-test was used to compare postpartum BGL change between regions.
Results: Over 10 years, there were 1452 GDM pregnancies in 1316 women. 35% were from the West, 21% East-Asia, 28% South-Asia, 4% Pacific Islands and 7% Middle-East/Afghanistan. 1315 women had antenatal GTT results available. Birth regions were similarly distributed in the 632 with postnatal results.
On antenatal testing, 29% of women born in the West had elevated fasting BGL, compared with 43% of Pacific Island women (p=0.043, OR1.8) and 13% of East-Asian women (p<0.001, OR0.4). In contrast, 89% of women from the West had elevated 2hr-BGL compared with 95% of East-Asians and 94% of South-Asians (p<0.05).
Postnatally, Pacific Islander and East-Asian women were more likely to have postpartum dysglycaemia than Western counterparts (OR3.1, p=0.02 and OR1.7, p=0.05 respectively). East-Asian women were three times less likely to have abnormal fasting BGL (p=0.01), but 2.6 times more likely to have abnormal 2hr-BGL (p=0.001). Pacific Islander women were 4 times more likely to have abnormal 2hr-BGL (p=0.007). Mean 2hr-BGL decreased in all groups on postnatal testing, but with significantly less improvement in East-Asians (p=0.018).
Percentage weight-gain during pregnancy was greater in East and South-Asians and Middle Easterners, compared to the Westerners. Weight-gain correlated with postnatal fasting BGL in women from the West and South-Asia.
Conclusion: Differences in pre/postpartum glucose tolerance may reflect different pathogenic mechanisms of GDM related to ethnicity.