(443) Pregnancy outcomes in gestational diabetes mellitus: ethnic-specific differences among a diverse Asian-American population

Objective: The prevalence of gestational diabetes mellitus (GDM) is higher in Asian populations. Comparative data on pregnancy outcomes among specific ethnic groups within Asian cohorts is lacking. Our objective was to study Asian patients with GDM and describe perinatal outcomes by country of origin.

Study Design: Retrospective cohort study of Asian patients with GDM stratified by region of origin (East: China, Korea, Japan, Taiwan; Southeast: Philippines, Thailand, Vietnam; South: India) who delivered at a single institution from 2020-2023. Classification of race/ethnicity was self-reported. Data were obtained through chart abstraction. Comparisons were performed using χ² and t-test. Multivariable logistic regression was then performed to adjust for potential confounders.

Results: We identified 667 patients with GDM during the study period, of whom 274 (41%) identified as Asian (36% East, 32% Southeast, 32% South). Specific ethnic groups within each region are shown in the Figure. Southeast and South Asian patients were more likely to be obese compared to those from Eastern regions (27% and 26% vs 11%, P=0.01) (Table). South Asian patients were more likely to require insulin for blood glucose management and to develop poor glycemic control, defined as failure to meet recommended glycemic targets > 50% of the time despite medical therapy. Southeast Asian patients were more likely to require rapid-acting insulin and to develop a hypertensive disorder of pregnancy. Other maternal and neonatal outcomes were similar between groups. After adjustment for obesity, Southeast and South Asian patients remained more likely to require insulin compared to East Asian patients (aOR 3.0, CI 1.5-5.8 and aOR 2.0, CI 1.1-4). Poor glycemic control remained associated with South Asian descent compared to East Asian after adjustment for obesity (aOR 2.5, CI 1.1-5.9).

Conclusion: There are differences in glycemic management between Asian ethnic groups. Though Asian race is a known risk factor for GDM, patients who identify as Asian represent a heterogeneous group with diverse backgrounds and different clinical outcomes.