title: Ethnic differences translate to inadequacy of high-risk screening for gestational diabetes mellitus in an Asian population: a cohort study.
abstract: BACKGROUND
  Universal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated. Few studies have assessed GDM screening in Asian populations and even fewer have compared Asian ethnic groups in a single multi-ethnic population.
  
  
  METHODS
  1136 pregnant women (56.7% Chinese, 25.5% Malay and 17.8% Indian) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study were screened for GDM by 75-g oral glucose tolerance test (OGTT) at 26-28 weeks of gestation. GDM was defined using the World Health Organization (WHO) criteria. High-risk screening is based on the guidelines of the UK National Institute for Health and Clinical Excellence.
  
  
  RESULTS
  Universal screening detected significantly more cases than high-risk screening [crude OR 2.2 (95% CI 1.7-2.8)], particularly for Chinese women [crude OR = 3.5 (95% CI 2.5-5.0)]. Pre-pregnancy BMI > 30 kg/m2 (adjusted OR = 3.4, 95% CI 1.5-7.9) and previous GDM history (adjusted OR = 6.6, 95% CI 1.2-37.3) were associated with increased risk of GDM in Malay women while GDM history was the only significant risk factor for GDM in Chinese women (adjusted OR = 4.7, 95% CI 2.0-11.0).
  
  
  CONCLUSIONS
  Risk factors used in high-risk screening do not sufficiently predict GDM risk and failed to detect half the GDM cases in Asian women. Asian women, particularly Chinese, should be screened to avoid under-diagnosis of GDM and thereby optimize maternal and fetal outcomes.
authors.affiliation: Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore 119228, Singapore. obgcys@nus.edu.sg.
authors.forename: Yap-Seng
authors.initials: YS
authors.lastname: Chong
authors.forename: Shirong
authors.initials: S
authors.lastname: Cai
authors.forename: Harvard
authors.initials: H
authors.lastname: Lin
authors.forename: Shu E
authors.initials: SE
authors.lastname: Soh
authors.forename: Yung-Seng
authors.initials: YS
authors.lastname: Lee
authors.forename: Melvin Khee-Shing
authors.initials: MK
authors.lastname: Leow
authors.forename: Yiong-Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.forename: Joanna D
authors.initials: JD
authors.lastname: Holbrook
authors.forename: Kok-Hian
authors.initials: KH
authors.lastname: Tan
authors.forename: Victor Samuel
authors.initials: VS
authors.lastname: Rajadurai
authors.forename: George Seow-Heong
authors.initials: GS
authors.lastname: Yeo
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
authors.forename: Seang-Mei
authors.initials: SM
authors.lastname: Saw
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gluckman
authors.forename: Keith M
authors.initials: KM
authors.lastname: Godfrey
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kwek
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002681:China / Q000208:ethnology; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000208:ethnology* / Q000235:genetics; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015995:Prevalence; D017584:Reproductive History; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012846:Singapore / Q000453:epidemiology; D055815:Young Adult