Maternal and Child Health Journal

, Volume 16, Issue 2, pp 364–373 | Cite as

Ethnic Differences in the Association Between Gestational Diabetes and Pregnancy Outcome



The purpose of the study was to examine ethnic variation in the impact of Gestational Diabetes Mellitus (GDM) on birth outcome. The authors examined the association between GDM and pregnancy-induced hypertension, macrosomia, primary Cesarean delivery, and preterm birth, using New York City Birth Certificate data from 2001–2006. Logistic regression was used to evaluate the crude and adjusted odds ratios of GDM with each adverse perinatal event, stratified by ethnicity. GDM was associated with increased risk of adverse perinatal events among all ethnic groups, with modest variation by ethnicity. Across ethnic groups, adjusted odds ratios comparing women with and without GDM ranged from 1.4–2.9 for pregnancy-induced hypertension, 1.0–2.2 for macrosomia, 1.1–1.8 for primary Cesarean delivery, and 1.3–1.8 for preterm birth. Overall, Caribbean, Sub-Saharan African, and African American women tended to show a larger relative impact of GDM, while North African, South Central Asian, and Chinese women showed a comparatively smaller impact of GDM. Although some ethnic variation was seen, differences in effect size were not large enough to support ethnic-specific thresholds for GDM diagnosis and treatment.


Gestational diabetes mellitus Ethnicity New York City Macrosomia Cesarean 



Data was obtained from the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene.


  1. 1.
    Thorpe, L. E., Berger, D., Ellis, J. A., et al. (2005). Trends and racial/ethnic disparities in gestational diabetes among pregnant women in New York City, 1990–2001. American Journal of Public Health, 95(9), 1536–1539.PubMedCrossRefGoogle Scholar
  2. 2.
    Baraban, E., McCoy, L., & Simon, P. (2008). Increasing prevalence of gestational diabetes and pregnancy-related hypertension in Los Angeles County, California, 1991–2003. Preventing chronic disease, 5(3), A77.PubMedGoogle Scholar
  3. 3.
    Getahun, D., Nath, C., Anath, C. V., et al. (2008). Gestational diabetes in the United States: Temporal trends 1989 through 2004. American Journal of Obstetrics and Gynecology, 198((5), 525.PubMedGoogle Scholar
  4. 4.
    Savitz, D. A., Janevic, T. M., Engel, S. M., et al. (2008). Ethnicity and gestational diabetes in New York City, 1995–2003. BJOG, 115((8), 969–978.PubMedGoogle Scholar
  5. 5.
    Rosenberg, T. J., Garbers, S., Lipkind, H., et al. (2005). Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: Differences among 4 racial/ethnic groups. American Journal of Public Health, 95((9), 1545–1551.PubMedCrossRefGoogle Scholar
  6. 6.
    Hunt, K. J., & Schuller, K. L. (2007). The increasing prevalence of diabetes in pregnancy. Obstetrics and Gynecology Clinics of North America, 34(2), 173–199.PubMedCrossRefGoogle Scholar
  7. 7.
    Green, J. R., Pawson, I. G., Schumacher, L. B., et al. (1990). Glucose tolerance in pregnancy: ethnic variation and influence of body habitus. Am J Obstet Gynecol, 163(1 Pt 1), 86–92.PubMedGoogle Scholar
  8. 8.
    Green, J. R., Schumacher, L. B., Pawson, I. G., et al. (1991). Influence of maternal body habitus and glucose tolerance on birth weight. Obstetrics and Gynecology, 78(2), 235–240.PubMedGoogle Scholar
  9. 9.
    Nahum, G. G., & Huffaker, B. J. (1993). Racial differences in oral glucose screening test results: Establishing race-specific criteria for abnormality in pregnancy. Obstetrics and Gynecology, 81(4), 517–522.PubMedGoogle Scholar
  10. 10.
    Scholl, T. O., Chen, X., Gaughan, C., et al. (2002). Influence of maternal glucose level on ethnic differences in birth weight and pregnancy outcome. American Journal of Epidemiology, 156(6), 498–506.PubMedCrossRefGoogle Scholar
  11. 11.
    HAPO Study Cooperative Research Group. (2009). Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Association with neonatal anthropometrics. Diabetes, 58, 453–459.CrossRefGoogle Scholar
  12. 12.
    HAPO Study Cooperative Research Group. (2008). Hyperglycemia and Adverse Pregnancy Outcomes. NEJM, 358(19), 1991–2002.CrossRefGoogle Scholar
  13. 13.
    Leikin, E. L., Jenkins, J. H., Pomerantz, G. A., et al. (1987). Abnormal glucose screening tests in pregnancy: A risk factor for fetal macrosomia. Obstetrics and Gynecology, 69(4), 570–573.PubMedGoogle Scholar
  14. 14.
    Kieffer, E. C., Alexander, G. R., Kogan, M. D., et al. (1998). Influence of diabetes during pregnancy on gestational age-specific newborn weight among US black and US white infants. American Journal of Epidemiology, 147(11), 1053–1061.PubMedGoogle Scholar
  15. 15.
    Saldana, T. M., Siega-Riz, A. M., Adair, L. S., et al. (2003). The association between impaired glucose tolerance and birth weight among black and white women in central North Carolina. Diabetes Care, 26((3), 656–661.PubMedCrossRefGoogle Scholar
  16. 16.
    Kieffer, E. C., Martin, J. A., & Herman, W. H. (1999). Impact of maternal nativity on the prevalence of diabetes during pregnancy among U.S. ethnic groups. Diabetes Care, 22(5), 729–735.PubMedCrossRefGoogle Scholar
  17. 17.
    Goldenberg, R. L., Cliver, S. P., Mulvihill, F., et al. (1996). Medical, psychosocial, and behavioral risk factors do not explain the increased risk for low birth weight among black women. American Journal of Obstetrics and Gynecology, 175(5), 1317–1324.PubMedCrossRefGoogle Scholar
  18. 18.
    Dunne, F. P., Brydon, P. A., Proffitt, M., et al. (2000). Fetal and maternal outcomes in Indo-Asian compared to Caucasian women with diabetes in pregnancy. QJ Med, 913, 813–818.CrossRefGoogle Scholar
  19. 19.
    Verheijen, E. C. J., Critchley, J. A., Whitelaw, D. C., et al. (2005). Outcomes of pregnancies in women with pre-existing type 1 or type 2 diabetes, in an ethnically mixed population. BJOG, 112, 1500–1503.PubMedCrossRefGoogle Scholar
  20. 20.
    Homko, C. J., Sivan, E., Nyirjesy, P., et al. (1995). The interrelationship between ethnicity and gestational diabetes in fetal macrosomia. Diabetes Care, 18(11), 1442–1445.PubMedCrossRefGoogle Scholar
  21. 21.
    Esakoff, T., Cheng, Y., & Caughey, A. (2005). Screening for gestational diabetes: Different cut-offs for different ethnicities? American Journal of Obstetrics and Gynecology, 193, 1040–1044.PubMedCrossRefGoogle Scholar
  22. 22.
    Koklanaris, N., Bonnano, C., Seubert, D., et al. (2007). Does raising the glucose challenge test threshold impact birthweight in Asian gravidas? Journal of Perinatal Medicine, 35, 100–103.PubMedCrossRefGoogle Scholar
  23. 23.
    Simmons, D. (2007). Relationship between maternal glycaemia and birth weight in glucose-tolerant women from different ethnic groups in New Zealand. Diabetic Medicine, 24, 240–244.PubMedCrossRefGoogle Scholar
  24. 24.
    Ananth, C. V. (2007). Menstrual versus clinical estimate of gestational age dating in the United States: Temporal trends and variability in indices of perinatal outcomes. Paediatric and Perinatal Epidemiology, 21(Suppl. 2), 22–30.PubMedCrossRefGoogle Scholar
  25. 25.
    Mustafa, G., & David, R. J. (2001). Comparative accuracy of clinical estimate versus menstrual gestational age in computerized birth certificates. Public Health Reports, 116, 15–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Phillipou, G., & Phillips, P. J. (1993). Racial differences in oral glucose screening test results: Establishing race-specific criteria for abnormality in pregnancy. Obstetrics and Gynecology, 82(3), 479–480.PubMedGoogle Scholar
  27. 27.
    Scholl, T. O., Sowers, M., Chen, X., et al. (2001). Maternal glucose concentration influences fetal gestation, and pregnancy complications. American Journal of Epidemiology, 154, 514–520.PubMedCrossRefGoogle Scholar
  28. 28.
    SAS Institute Inc. SAS OnlineDoc 9.1.3. Cary, NC: SAS Institute Inc.; 2005.Google Scholar
  29. 29.
    Koukkou, E., Taub, N., Jackson, P., et al. (1995). Difference in prevalence of gestational diabetes and perinatal outcome in an innercity multiethnic London population. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 59(2), 153–157.PubMedCrossRefGoogle Scholar
  30. 30.
    Baumeister, L., Marchi, K., Pearl, M., et al. (2000). The validity of information on “race” and “Hispanic ethnicity” in California birth certificate data. Health Services Research, 35(4), 869–883.PubMedGoogle Scholar
  31. 31.
    Dobie, S. A., Baldwin, L. M., Rosenblatt, R. A., et al. (1998). How well do birth certificates describe the pregnancies they report? The Washington State experience with low-risk pregnancies. Maternal and Child Health Journal, 2(3), 145–154.PubMedCrossRefGoogle Scholar
  32. 32.
    Piper, J. M., Mitchel, E. F, Jr, Snowden, M., et al. (1993). Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records. American Journal of Epidemiology, 137(7), 758–768.PubMedGoogle Scholar
  33. 33.
    Lydon-Rochelle, M. T., Holt, V. L., Cardenas, V., et al. (2005). The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. American Journal of Obstetrics and Gynecology, 193(1), 125–134.PubMedCrossRefGoogle Scholar
  34. 34.
    Roohan, P. J., Josberger, R. E., Acar, J., et al. (2003). Validation of birth certificate data in New York State. Journal of Community Health, 28(5), 335–346.PubMedCrossRefGoogle Scholar
  35. 35.
    Reichman NE, Schwartz-Soicher O (2007) Accuracy of birth certificate data by risk factors and outcomes: analysis of data from New Jersey. AJOG.;197:32.e1–32.e8.Google Scholar
  36. 36.
    Northam, S., & Knapp, T. R. (2006). The reliability and validity of birth certificates. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35(1), 3–12.PubMedCrossRefGoogle Scholar
  37. 37.
    Buescher, P. A., Taylor, K. P., Davis, M. H., et al. (1993). The quality of the new birth certificate data: A validation study in North Carolina. American Journal of Public Health, 83(8), 1163–1165.PubMedCrossRefGoogle Scholar
  38. 38.
    Reichman, N. E., & Schwartz-Soicher, O. (2007). Accuracy of birth certificate data by risk factors and outcomes: analysis of data from New Jersey. American Journal of Obstetrics and Gynecology, 197(1), e1–e8.PubMedCrossRefGoogle Scholar
  39. 39.
    Roberts, C. L., Bell, J. C., Ford, J. B., et al. (2008). The accuracy of reporting of the hypertensive disorders of pregnancy in population health data. Hypertens Pregnancy, 27(3), 285–297.PubMedCrossRefGoogle Scholar
  40. 40.
    Reichman, N. E., & Hade, E. M. (2001). Validation of birth certificate data. A study of women in New Jersey’s HealthStart program. Ann Epidemiol, 11(3), 186–193.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.Departments of Community Health and Obstetrics and GynecologyBrown UniversityProvidenceUSA

Personalised recommendations