Risk of Adverse Pregnancy Outcomes among Asian Individuals with Gestational Diabetes Mellitus in the United States, 2016-2021

Objective: The risk of adverse pregnancy outcomes (APOs) differs among race and ethnic groups with gestational diabetes mellitus (GDM). Heterogeneity in APOs may be masked by aggregating these groups. We assessed whether the frequency and risk of APOs differed among Asian groups with GDM.

Research Design and Methods: This is a serial cross-sectional analysis of US birth certificate data (2016-2021) from individuals with a singleton first live birth. The exposure was self-reported maternal race and ethnicity stratified by Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese versus non-Hispanic White as the reference. Maternal outcomes included: primary cesarean delivery, hypertensive disorders of pregnancy (HDP), intensive care unit admission, and transfusion. Neonatal outcomes included: large-for-gestational-age (LGA), small-for-gestational-age (SGA), preterm birth, and NICU admission.

Results: The study population included 29,370 Indian, 16,146 Chinese, 9,082 Filipino, 6,497 Vietnamese, 3,754 Korean, and 1,253 Japanese individuals, and 254,433 White individuals. Between 2016 to 2021, the frequency of HDP, but not other APOs, increased among most Asian groups. In multivariable analyses, individuals in all Asian groups had higher likelihood of SGA and lower likelihood of LGA compared with White individuals. Findings for other APOs were heterogeneous. The risk of APOs was generally highest among Filipino followed by Indian individuals and lowest among Chinese individuals among Asian groups.

Conclusions: There was significant heterogeneity in the frequency and risk of APOs among Asian individuals with GDM in the US. Disaggregation of the Asian population in diabetes and pregnancy research and surveillance is necessary to identify opportunities for intervention.