gestational diabetes among asian american women: a paradox in disease burden tam h. nguyen, phd,...

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

…. A paradox in disease burden

So how big of a burden is GDM among Asian Americans?

Prevalence of GDM among Asian Americans & Problems with data

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

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: >

Systematic review of GDM prevalence among Asian Americans

Medline61

CINAHL73

Embase99

Abstracts Reviewed(n=206)

Reviewer 1Screening of all titles and abstracts

Reviewer 1Full text review for inclusion (n=32)

Reviewer 2Screening of all titles and abstracts

Reviewer 2Full text review for inclusion (n=25)

ConsensusAgreed + Individual (n=26)

Included publications(n=14)

Duplicates: (n=27)

Rejected based on title & abstract:

(n=181)

Rejected based on title & abstract:

(n=174)

Excluded References Did not meet inclusion criteria (n=12)

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

PrevalenceAAPI: 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

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

Preventing GDM

Choose good fats over bad fats

Limit red meat & processed meat

If you smoke, try to quit

Avoid stress

THANK YOU

tam.nguyen@bc.edu

Eat Less, Move More