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Open Access 01-12-2021 | Gestational Diabetes | Research

Comparative epidemiology of gestational diabetes in ethnic Chinese from Shanghai birth cohort and growing up in Singapore towards healthy outcomes cohort

Authors: Evelyn Xiu Ling Loo, Yuqing Zhang, Qai Ven Yap, Guoqi Yu, Shu E Soh, See Ling Loy, Hui Xing Lau, Shiao-Yng Chan, Lynette Pei-Chi Shek, Zhong-Cheng Luo, Fabian Kok Peng Yap, Kok Hian Tan, Yap Seng Chong, Jun Zhang, Johan Gunnar Eriksson

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

Gestational diabetes mellitus (GDM) has been associated with adverse health outcomes for mothers and offspring. Prevalence of GDM differs by country/region due to ethnicity, lifestyle and diagnostic criteria. We compared GDM rates and risk factors in two Asian cohorts using the 1999 WHO and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.

Methods

The Shanghai Birth Cohort (SBC) and the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort are prospective birth cohorts. Information on sociodemographic characteristics and medical history were collected from interviewer-administered questionnaires. Participants underwent a 2-h 75-g oral glucose tolerance test at 24–28 weeks gestation. Logistic regressions were performed.

Results

Using the 1999 WHO criteria, the prevalence of GDM was higher in GUSTO (20.8%) compared to SBC (16.6%) (p = 0.046). Family history of hypertension and alcohol consumption were associated with higher odds of GDM in SBC than in GUSTO cohort while obesity was associated with higher odds of GDM in GUSTO. Using the IADPSG criteria, the prevalence of GDM was 14.3% in SBC versus 12.0% in GUSTO. A history of GDM was associated with higher odds of GDM in GUSTO than in SBC, while being overweight, alcohol consumption and family history of diabetes were associated with higher odds of GDM in SBC.

Conclusions

We observed several differential risk factors of GDM among ethnic Chinese women living in Shanghai and Singapore. These findings might be due to heterogeneity of GDM reflected in diagnostic criteria as well as in unmeasured genetic, lifestyle and environmental factors.

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Waterland RA, Michels KB. Epigenetic epidemiology of the developmental origins hypothesis. Annu Rev Nutr. 2007;27(1):363–88. https://doi.org/10.1146/annurev.nutr.27.061406.093705.CrossRefPubMed

Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005;115(3):485–91. https://doi.org/10.1172/JCI200524531.CrossRefPubMedPubMedCentral

Cho N, Shaw J, Karuranga S, Huang Y, da Rocha FJ, Ohlrogge A, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–81. https://doi.org/10.1016/j.diabres.2018.02.023.CrossRef

National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes. 1979;28(12):1039–57. https://doi.org/10.2337/diab.28.12.1039.CrossRef

Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862–8. https://doi.org/10.2337/diacare.25.10.1862.CrossRefPubMed

Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia. 2019;62(6):905–14. https://doi.org/10.1007/s00125-019-4840-2.CrossRefPubMed

Beharier O, Shoham-Vardi I, Pariente G, Sergienko R, Kessous R, Baumfeld Y, et al. Gestational diabetes mellitus is a significant risk factor for long-term maternal renal disease. J Clin Endocrinol Metab. 2015;100(4):1412–6. https://doi.org/10.1210/jc.2014-4474.CrossRefPubMed

Kamana K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab. 2015;66(Suppl. 2):14–20.CrossRef

Elliott HR, Sharp GC, Relton CL, Lawlor DA. Epigenetics and gestational diabetes: a review of epigenetic epidemiology studies and their use to explore epigenetic mediation and improve prediction. Diabetologia. 2019;62:2171–8.

10.

Teh WT, Teede HJ, Paul E, Harrison CL, Wallace EM, Allan C. Risk factors for gestational diabetes mellitus: implications for the application of screening guidelines. Aust N Z J Obstet Gynaecol. 2011;51(1):26–30. https://doi.org/10.1111/j.1479-828X.2011.01292.x.CrossRefPubMed

11.

Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30(8):2070–6. https://doi.org/10.2337/dc06-2559a.CrossRefPubMed

12.

Hantoushzadeh S, Sheikh M, Bosaghzadeh Z, Ghotbizadeh F, Tarafdari A, Panahi Z, et al. The impact of gestational weight gain in different trimesters of pregnancy on glucose challenge test and gestational diabetes. Postgrad Med J. 2016;92(1091):520–4. https://doi.org/10.1136/postgradmedj-2015-133816.CrossRefPubMed

13.

Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010;115(3):597–604. https://doi.org/10.1097/AOG.0b013e3181cfce4f.CrossRefPubMedPubMedCentral

14.

Solomon CG, Willett WC, Carey VJ, Rich-Edwards J, Hunter DJ, Colditz GA, et al. A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA. 1997;278(13):1078–83. https://doi.org/10.1001/jama.1997.03550130052036.CrossRefPubMed

15.

Zhang C, Ning Y. Effect of dietary and lifestyle factors on the risk of gestational diabetes: review of epidemiologic evidence. Am J Clin Nutr. 2011;94(suppl_6):1975S–9S.CrossRef

16.

Eades CE, Cameron DM, Evans JM. Prevalence of gestational diabetes mellitus in Europe: a meta-analysis. Diabetes Res Clin Pract. 2017;129:173–81. https://doi.org/10.1016/j.diabres.2017.03.030.CrossRefPubMed

17.

Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018;18(1):494. https://doi.org/10.1186/s12884-018-2131-4.CrossRefPubMedPubMedCentral

18.

Yew T, Khoo C, Thai A, Kale A, Yong E, Tai E. The prevalence of gestational diabetes mellitus among Asian females is lower using the new 2013 World Health Organization diagnostic criteria. Endocr Pract. 2014;20(10):1064–9. https://doi.org/10.4158/EP14028.OR.CrossRefPubMed

19.

Zheng T, Ye W, Wang X, Li X, Zhang J, Little J, et al. A simple model to predict risk of gestational diabetes mellitus from 8 to 20 weeks of gestation in Chinese women. BMC Pregnancy Childbirth. 2019;19(1):252. https://doi.org/10.1186/s12884-019-2374-8.CrossRefPubMedPubMedCentral

20.

Zhang J, Tian Y, Wang W, Ouyang F, Xu J, Yu X, et al. Cohort profile: the Shanghai birth cohort. Int J Epidemiol. 2019;48(1):21–21g.CrossRef

21.

Soh S-E, Tint MT, Gluckman PD, Godfrey KM, Rifkin-Graboi A, Chan YH, et al. Cohort profile: growing up in Singapore towards healthy outcomes (GUSTO) birth cohort study. Int J Epidemiol. 2014;43(5):1401–9. https://doi.org/10.1093/ije/dyt125.CrossRefPubMed

22.

WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.CrossRef

23.

Mikolajczyk RT, Zhang J, Betran AP, Souza JP, Mori R, Gülmezoglu AM, et al. A global reference for fetal-weight and birthweight percentiles. Lancet. 2011;377(9780):1855–61. https://doi.org/10.1016/S0140-6736(11)60364-4.CrossRefPubMed

24.

Li Y, Ren X, He L, Li J, Zhang S, Chen W. Maternal age and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of over 120 million participants. Diabetes Res Clin Pract. 2020;162:108044. https://doi.org/10.1016/j.diabres.2020.108044.CrossRefPubMed

25.

Yang H, Wei Y, Gao X, Xu X, Fan L, He J, et al. Risk factors for gestational diabetes mellitus in Chinese women—a prospective study of 16 286 pregnant women in China. Diabet Med. 2009;26(11):1099–104. https://doi.org/10.1111/j.1464-5491.2009.02845.x.CrossRefPubMed

26.

Sepe A, Tchkonia T, Thomou T, Zamboni M, Kirkland JL. Aging and regional differences in fat cell progenitors – a mini-review. Gerontology. 2011;57(1):66–75. https://doi.org/10.1159/000279755.CrossRefPubMed

27.

Snel M, Jonker JT, Schoones J, Lamb H, de Roos A, Pijl H, et al. Ectopic fat and insulin resistance: pathophysiology and effect of diet and lifestyle interventions. Int J Endocrinol. 2012;2012:1–18. https://doi.org/10.1155/2012/983814.CrossRef

28.

Torloni M, Betran A, Horta B, Nakamura M, Atallah A, Moron A, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev. 2009;10(2):194–203. https://doi.org/10.1111/j.1467-789X.2008.00541.x.CrossRefPubMed

29.

Lee H, Lee IS, Choue R. Obesity, inflammation and diet. Pediatr Gastroenterol Hepatol Nutr. 2013;16(3):143–52. https://doi.org/10.5223/pghn.2013.16.3.143.CrossRefPubMedPubMedCentral

30.

Shiwaku K, Anuurad E, Enkhmaa B, Kitajima K, Yamane Y. Appropriate BMI for Asian populations. Lancet. 2004;363(9414):1077. https://doi.org/10.1016/S0140-6736(04)15856-X.CrossRefPubMed

31.

Shaukat S, Nur U. Effect of prepregnancy maternal BMI on adverse pregnancy and neonatal outcomes: results from a retrospective cohort study of a multiethnic population in Qatar. BMJ Open. 2019;9(9):e029757. https://doi.org/10.1136/bmjopen-2019-029757.CrossRefPubMedPubMedCentral

32.

Tsiotra PC, Halvatsiotis P, Patsouras K, Maratou E, Salamalekis G, Raptis SA, et al. Circulating adipokines and mRNA expression in adipose tissue and the placenta in women with gestational diabetes mellitus. Peptides. 2018;101:157–66. https://doi.org/10.1016/j.peptides.2018.01.005.CrossRefPubMed

33.

Zhang C, Bao W, Rong Y, Yang H, Bowers K, Yeung E, et al. Genetic variants and the risk of gestational diabetes mellitus: a systematic review. Hum Reprod Update. 2013;19(4):376–90. https://doi.org/10.1093/humupd/dmt013.CrossRefPubMedPubMedCentral

34.

Ma R, Hu C, Tam C, Zhang R, Kwan P, Leung T, et al. Genome-wide association study in a Chinese population identifies a susceptibility locus for type 2 diabetes at 7q32 near PAX4. Diabetologia. 2013;56(6):1291–305. https://doi.org/10.1007/s00125-013-2874-4.CrossRefPubMedPubMedCentral

35.

Qi Q, Wang X, Strizich G, Wang T. Genetic determinants of type 2 diabetes in Asians. Int J Diabetol Vasc Dis Res. 2015;2015(Suppl 1):1–9.

36.

Ruhstaller K, Bastek J, Thomas A, McElrath T, Parry S, Durnwald C. Initial BMI, not early weight gain, increases the risk of GDM. Am J Obstet Gynecol. 2015;212(1):S396.

37.

Cao M, Zhang L, Chen T, Shi A, Xie K, Li Z, et al. Genetic susceptibility to gestational diabetes mellitus in a Chinese population. Front Endocrinol (Lausanne). 2020;11:247.CrossRef

38.

Tan JT, Dorajoo R, Seielstad M, Sim XL, Ong RT-H, Chia KS, et al. FTO variants are associated with obesity in the Chinese and Malay populations in Singapore. Diabetes. 2008;57(10):2851–7. https://doi.org/10.2337/db08-0214.CrossRefPubMedPubMedCentral

39.

Cedernaes J, Schönke M, Westholm JO, Mi J, Chibalin A, Voisin S, et al. Acute sleep loss results in tissue-specific alterations in genome-wide DNA methylation state and metabolic fuel utilization in humans. Sci Adv. 2018;4(8):eaar8590.CrossRef

40.

Cai S, Tan S, Gluckman PD, Godfrey KM, Saw S-M, Teoh OH, et al. Sleep quality and nocturnal sleep duration in pregnancy and risk of gestational diabetes mellitus. Sleep. 2017;40(2):zsw058.

41.

Dunleavy G, Bajpai R, Comiran Tonon A, Chua AP, Cheung KL, Soh C-K, et al. Examining the factor structure of the Pittsburgh sleep quality index in a multi-ethnic working population in Singapore. Int J Environ Res Public Health. 2019;16(23):4590. https://doi.org/10.3390/ijerph16234590.CrossRefPubMedCentral

42.

Wu W, Jiang Y, Wang N, Zhu M, Liu X, Jiang F, et al. Sleep quality of Shanghai residents: population-based cross-sectional study. Qual Life Res. 2020;29(4):1055–64. https://doi.org/10.1007/s11136-019-02371-x.CrossRefPubMed

43.

Ling C, Rönn T. Epigenetics in human obesity and type 2 diabetes. Cell Metab. 2019;29(5):1028–44. https://doi.org/10.1016/j.cmet.2019.03.009.CrossRefPubMedPubMedCentral

44.

Hughes K, Ong C-N. Homocysteine, folate, vitamin B12, and cardiovascular risk in Indians, Malays, and Chinese in Singapore. J Epidemiol Community Health. 2000;54(1):31–4. https://doi.org/10.1136/jech.54.1.31.CrossRefPubMedPubMedCentral

45.

Hao L, Ma J, Stampfer MJ, Ren A, Tian Y, Tang Y, et al. Geographical, seasonal and gender differences in folate status among Chinese adults. J Nutr. 2003;133(11):3630–5. https://doi.org/10.1093/jn/133.11.3630.CrossRefPubMed

46.

Du HY, Jiang H, Karmin O, Chen B, Xu LJ, Liu SP, et al. Association of Dietary Pattern during pregnancy and gestational diabetes mellitus: a prospective cohort study in northern China. Biomed Environ Sci. 2017;30(12):887–97. https://doi.org/10.3967/bes2017.119.CrossRefPubMed

47.

de Seymour J, Chia A, Colega M, Jones B, McKenzie E, Shirong C, et al. Maternal dietary patterns and gestational diabetes mellitus in a multi-ethnic Asian cohort: the GUSTO study. Nutrients. 2016;8(9):574.

48.

Xiang M, Zhang J, Liang H, Zhang Z, Konishi M, Hu H, et al. Physical activity and dietary intake among Chinese pregnant women: an observational study. BMC Pregnancy Childbirth. 2019;19(1):1–8.CrossRef

49.

Simeonova-Krstevska S, Velkoska Nakova V, Samardziski I, Atanasova Bosku A, Todorovska I, Sima A, et al. Perinatal outcome in gestational diabetes Melitus vs Normoglycemic women. Biomed J Sci Tech Res. 2020;26(2):19882–8.

50.

Yang Y, Wang Z, Mo M, Muyiduli X, Wang S, Li M, et al. The association of gestational diabetes mellitus with fetal birth weight. J Diabetes Complicat. 2018;32(7):635–42. https://doi.org/10.1016/j.jdiacomp.2018.04.008.CrossRef

51.

Vally F, Presneill J, Cade T. Macrosomia rates in women with diet-controlled gestational diabetes: a retrospective study. J Pregnancy. 2017;2017:1–5. https://doi.org/10.1155/2017/4935397.CrossRef

52.

Wan CS, Nankervis A, Teede H, Aroni R. Dietary intervention strategies for ethnic Chinese women with gestational diabetes mellitus: a systematic review and meta-analysis. Nutr Diet. 2019;76(2):211–32. https://doi.org/10.1111/1747-0080.12524.CrossRefPubMedPubMedCentral

53.

Brown FM, Wyckoff J. Application of one-step IADPSG versus two-step diagnostic criteria for gestational diabetes in the real world: impact on health services, clinical care, and outcomes. Curr Diab Rep. 2017;17(10):85. https://doi.org/10.1007/s11892-017-0922-z.CrossRefPubMedPubMedCentral

54.

Shen S, Lu J, Zhang L, He J, Li W, Chen N, et al. Single fasting plasma glucose versus 75-g oral glucose-tolerance test in prediction of adverse perinatal outcomes: a cohort study. EBioMedicine. 2017;16:284–91. https://doi.org/10.1016/j.ebiom.2017.01.025.CrossRefPubMedPubMedCentral

55.

Black MH, Sacks DA, Xiang AH, Lawrence JM. Clinical outcomes of pregnancies complicated by mild gestational diabetes mellitus differ by combinations of abnormal oral glucose tolerance test values. Diabetes Care. 2010;33(12):2524–30. https://doi.org/10.2337/dc10-1445.CrossRefPubMedPubMedCentral

56.

Chi C, Loy SL, Chan S-Y, Choong C, Cai S, Soh SE, et al. Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study. BMC Pregnancy Childbirth. 2018;18(1):69. https://doi.org/10.1186/s12884-018-1707-3.CrossRefPubMedPubMedCentral

Title: Comparative epidemiology of gestational diabetes in ethnic Chinese from Shanghai birth cohort and growing up in Singapore towards healthy outcomes cohort
Authors: Evelyn Xiu Ling Loo
Yuqing Zhang
Qai Ven Yap
Guoqi Yu
Shu E Soh
See Ling Loy
Hui Xing Lau
Shiao-Yng Chan
Lynette Pei-Chi Shek
Zhong-Cheng Luo
Fabian Kok Peng Yap
Kok Hian Tan
Yap Seng Chong
Jun Zhang
Johan Gunnar Eriksson
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Gestational Diabetes
Diabetes and Pregnancy
Gestational Diabetes
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-04036-5

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Comparative epidemiology of gestational diabetes in ethnic Chinese from Shanghai birth cohort and growing up in Singapore towards healthy outcomes cohort

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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