Gestational diabetes in a multiethnic population of Spain: Clinical characteristics and perinatal outcomes

Aims: To compare clinical characteristics and perinatal outcomes between immigrant and Spanish women with gestational diabetes mellitus (GDM) in a multiethnic population of Barcelona and to identify factors independently associated with the development of large-for-gestational-age (LGA) infants. Methods: Prospective study of women with GDM from five ethnic groups (Caucasian, South-Central Asian, Latin American, East Asian and Moroccan) at a single institution in Barcelona between 2004 and 2011. Maternal, gestational and newborn characteristics were recorded. Results: The cohort included 456 patients. In univariate analyses, Moroccan women had more frequently a pre-gestational body mass index (BMI) > 25 kg/m(2) (76.4%, P = 0.012), while East Asian women had lower BMI (23.41 +/- 2.79 kg/m(2), P < 0.001), less need for insulin therapy (14.3%, P = 0.013) and the highest rate of spontaneous labor (69.8%, P = 0.014) and eutocic delivery (63.8%, P = 0.032). Also, Latin American women had a higher rate of Cesarean section (52.9%, P < 0.001) and LGA infants (28.6%, P = 0.004), and their newborns had lower umbilical cord pH (7.23 +/- 0.06, P = 0.005) and Apgar scores (9 [4-10], P < 0.01) and a higher incidence of neonatal hypoglycemia (51.4%, P = 0.045). Logistic regression analysis identified pre-gestational BMI (OR: 1.18; 95% CI: 1.09-1.27), pregnancy weight gain (OR: 1.19; 95% CI: 1.1-1.28) and insulin use during gestation (OR: 2.29; 95% CI: 1.09-4.82) as predictors of LGA infants. Conclusions: Significant ethnic differences were found in clinical characteristics and perinatal outcomes of women with GDM. Latin American women had a higher frequency of adverse perinatal outcomes. Pregestational BMI, pregnancy weight gain and insulin use during pregnancy were independent predictors of LGA. (C) 2013 Elsevier Ireland Ltd. All rights reserved.