Published online Jul 25, 2015. doi: 10.4239/wjd.v6.i8.1024
Peer-review started: August 23, 2014
First decision: February 7, 2015
Revised: April 22, 2015
Accepted: May 5, 2015
Article in press: May 6, 2015
Published online: July 25, 2015
Ethnicity is defined as “belonging to a social group that has a common national or cultural tradition”. Membership of certain ethnic groups has long been associated with increased risk of gestational diabetes mellitus (GDM). Studies that examined ethnic differences amongst women with GDM were often conducted in western countries where women from various ethnic backgrounds were represented. The prevalence of GDM appears to be particularly high among women from South Asia and South East Asia, compared to Caucasian, African-American and Hispanic communities. For some, but not all ethnic groups, the body mass index is a risk factor for the development of GDM. Even within a particular ethnic group, those who were born in their native countries have a different risk profile for GDM compared to those born in western countries. In terms of treatment, medical nutrition therapy (MNT) plays a key role in the management of GDM and the prescription of MNT should be culturally sensitive. Limited studies have shown that women who live in an English-speaking country but predominantly speak a language other than English, have lower rates of dietary understanding compared with their English speaking counterparts, and this may affect compliance to therapy. Insulin therapy also plays an important role and there appears to be variation as to the progression of women who progress to requiring insulin among different ethnicities. As for peri-natal outcomes, women from Pacific Islander countries have higher rates of macrosomia, while women from Chinese backgrounds had lower adverse pregnancy outcomes. From a maternal outcome point of view, pregnant women from Asia with GDM have a higher incidence of abnormal glucose tolerance test results post-partum and hence a higher risk of future development of type 2 diabetes mellitus. On the other hand, women from Hispanic or African-American backgrounds with GDM are more likely to develop hypertension post-partum. This review highlights the fact that management needs to be individualised and the clinician should be mindful of the impact that differences in ethnicity may have on the clinical characteristics and pregnancy outcomes in women affected by GDM, particularly those living in Western countries. Understanding these differences is critical in the delivery of optimal antenatal care for women from diverse ethnic backgrounds.
Core tip: The prevalence of gestational diabetes mellitus (GDM) is increasing world-wide, and studies have shown that optimal management of GDM improves pregnancy outcomes. This review summarises the differences in prevalence, clinical profile, management and pregnancy outcomes among women from various ethnic backgrounds who have GDM. Ethnicity is an important consideration in women affected by GDM, particularly in an antenatal service based in a Western society. There are particular challenges in individualising and tailoring medical nutritional therapy and insulin therapy. Also women from certain ethnic groups are at a higher risk of increased foetal and maternal morbidity and mortality. Understanding these challenges is important in providing optimal antenatal care for women of diverse ethnic backgrounds.