Diabetes Forecast

Helping Asian Americans Avoid Gestational Diabetes

Latha Palaniappan studies tailoring treatment for different Asian groups

Latha Palaniappan, MD

Photograph by Robert Houser

Latha Palaniappan, MD

Occupation: Epidemiologist, Palo Alto Medical Foundation, Palo Alto, Calif.
Focus: Gestational Diabetes
ADA Research Funding: Clinical Translational Award

Gestational diabetes, or diabetes that begins during pregnancy, affects almost 200,000 U.S. women each year. It’s one of the most common complications of pregnancy. Yet because of its seemingly temporary nature—the condition may disappear within hours of giving birth as the body’s hormones settle down from the tumult of pregnancy—it can get short shrift in the discussion about preventing and managing diabetes.

There’s no doubt gestational diabetes, left uncontrolled, is bad for babies. It can lead to macrosomia, a scientific term for “large body.” Macrosomic babies are often over 10 pounds at birth. “That can lead to various metabolic abnormalities, including an increased risk of cardiovascular disease for moms and babies,” says Latha Palaniappan, MD, an epidemiologist at the Palo Alto Medical Foundation in California. Birthing a bigger baby can lead to shoulder dislocations for the newborns, as well as more stillbirths.

Big babies are also health risks for moms. Macrosomia means more cesarean sections, more vaginal tears, and a greater risk of hemorrhaging. For moms, the metabolic effects of gestational diabetes can be long-lasting: By some estimates, fully half of women who experience gestational diabetes go on to develop type 2.

The causes of gestational diabetes are still not clear. Pregnancy leads to hormonal changes that can increase glucose levels and prompt the body to store more fat. At the same time, insulin production increases, unless the pancreas is unable to meet insulin requirements, as in diabetes. And finally, some researchers think the placenta might have something to do with insulin resistance, making the body less responsive to the signals insulin is communicating.

Pregnant women are screened for gestational diabetes using an oral glucose tolerance test, usually between their 24th and 28th week of pregnancy. About 5 in 100 come back with a positive result, Palaniappan says. Genetics, obesity, and prediabetes can increase the risks.

So, it seems, can ethnicity. Asian Americans, in particular, have high rates of gestational diabetes. The statistics are dramatic: 15 percent of one Asian group Palaniappan studied developed gestational diabetes, triple the rate for non-Hispanic whites, she says. “Asians, when you aggregate them, have higher rates of gestational diabetes and type 2 diabetes than non-Hispanic whites,” she adds. “Yet from my clinical experience, Asian American mothers are not aware they’re at higher risk.”

The term “Asian” is a major oversimplification. Many U.S. census forms draw no distinctions among Asian American groups. People of Chinese descent check the same box as ethnic Filipinos, for example. That means that when it comes to gestational diabetes, there may actually be significant ethnic differences that are overlooked.

In a recent study, Palaniappan found that women of Vietnamese descent were three times as likely to have gestational diabetes as Japanese American women. “Asians are often lumped together, but some groups are at much, much higher risk,” she says.

The findings have prompted Palaniappan to delve deeper, in the hopes of tailoring treatment for gestational diabetes to specific populations. With the help of a grant from the American Diabetes Association, she’s using electronic health records from California to look at how gestational diabetes affects different ethnic groups.

The data are stripped of all personal information. But she’s able to mine the data for information on everything from smoking and weight gain during pregnancy to birth weight and later issues, including type 2 diabetes. That way, Palaniappan can study thousands of patients. “It gives us a way to target high-risk groups and create culturally competent interventions,” she says.

Palaniappan’s findings are already highlighting places where blanket recommendations for things such as weight gain during pregnancy and even body mass index (a ratio of weight to height that is a rough measure of body fat) might be steering Asian patients wrong. Take the typical weight-gain recommended for normal-weight women in pregnancy: 25 to 30 pounds. It might be too high for some Asian groups, putting them at greater risk for gestational diabetes. “It’s important to make sure weight gain follows medical recommendations, but Asians may benefit from lower weight gain,” Palaniappan says.

For now, Palaniappan recommends that pregnant women discuss ways to manage gestational diabetes, such as eating plans and exercise, with their doctor. The basic message actually applies to everyone, not just women with gestational diabetes: “Avoid refined sugars, eat more whole grains, and eat whole fruits and vegetables instead of drinking juice,” Palaniappan says.

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