title: Racial/Ethnic Differences in Gestational Diabetes Prevalence and Contribution of Common Risk Factors.
abstract: BACKGROUND
  The White House, the American Heart Association, the Agency for Healthcare Research and Quality, and the National Heart, Lung and Blood Institute have all recently acknowledged the need to disaggregate Asian American subgroups to better understand this heterogeneous racial group. This study aims to assess racial/ethnic differences in relative contribution of risk factors of gestational diabetes mellitus (GDM) among Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese), Hispanics, non-Hispanic blacks, and non-Hispanic whites.
  
  
  METHODS
  Pregnant women in 2007-2012 were identified through California state birth certificate records and linked to the electronic health records in a large mixed-payer ambulatory care organisation in Northern California (n = 24 195). Relative risk and population attributable fraction (PAF) for specific racial/ethnic groups were calculated to assess the contributions of advanced maternal age, overweight/obesity (Centers for Disease Control and Prevention (CDC) standards and World Health Organization (WHO)/American Diabetes Association (ADA) body mass index cut-offs for Asians), family history of type 2 diabetes, and foreign-born status.
  
  
  RESULTS
  GDM was most prevalent among Asian Indians (19.3%). Relative risks were similar across all race/ethnic groups. Advanced maternal age had higher PAFs in non-Hispanic whites (22.5%) and Hispanics (22.7%). Meanwhile family history (Asian Indians 22.6%, Chinese 22.9%) and foreign-borne status (Chinese 40.2%, Filipinos 30.2%) had higher PAFs in Asian subgroups. Overweight/obesity was the most important GDM risk factor for non-Hispanic whites, Hispanics, Asian Indians, and Filipinos when the WHO/ADA cut-off points were applied. Advanced maternal age was the only risk factor studied that was modified by race/ethnicity, with non-Hispanic white and Hispanic women being more adversely affected than other racial/ethnic groups.
  
  
  CONCLUSIONS
  Overweight/obesity, advanced maternal age, family history of type 2 diabetes, and foreign-borne status are important risk factors for GDM. The relative contributions of these risk factors differ by race/ethnicity, mainly due to differences in population prevalence of these risk factors.
authors.affiliation: Research Institute, Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Jia
authors.initials: J
authors.lastname: Pu
authors.affiliation: Research Institute, Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Beinan
authors.initials: B
authors.lastname: Zhao
authors.affiliation: School of Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Elsie J
authors.initials: EJ
authors.lastname: Wang
authors.affiliation: Research Institute, Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Vani
authors.initials: V
authors.lastname: Nimbal
authors.affiliation: Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Osmundson
authors.affiliation: Research Institute, Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Liza
authors.initials: L
authors.lastname: Kunz
authors.affiliation: Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, CA.
authors.forename: Rita A
authors.initials: RA
authors.lastname: Popat
authors.affiliation: Research Institute, Palo Alto Medical Foundation, Palo Alto, CA.
authors.forename: Sukyung
authors.initials: S
authors.lastname: Chung
authors.affiliation: School of Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Latha P
authors.initials: LP
authors.lastname: Palaniappan
mesh_terms: D000328:Adult; D001741:Black or African American; D001213:Asian; D002140:California / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000209:etiology; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D044465:White People