Influence of Acculturation on Risk for Gestational Diabetes Among Asian Women

Liwei Chen, MD, PhD; Lu Shi, PhD; Donglan Zhang, PhD; Shin Margaret Chao, MPH, PhD


Prev Chronic Dis. 2019;16(12):E158 

In This Article

Abstract and Introduction


Introduction: Asian women have a higher prevalence of gestational diabetes mellitus than women of other races/ethnicities. We aimed to compare the prevalence of gestational diabetes among Asian American women to other racial/ethnic groups and explore whether the higher occurrence of the disorder among Asian women can be explained by acculturation.

Methods: We conducted a population-based, cross-sectional study among 5,562 women who participated in the 2007 Los Angeles Mommy and Baby Study (LAMB) in Los Angeles County, California. All women included in this study had a live delivery in 2007 and did not have pre-pregnancy type I or II diabetes. We applied multivariate, weighted logistic regressions to compare gestational diabetes prevalence among racial/ethnic groups, adjusting for its known risk factors. We conducted mediation analysis to test whether the difference in prevalence across racial/ethnic groups could be explained by acculturation.

Results: Among the 5,562 women studied, the weighted prevalence of gestational diabetes was 15.5% among Asian American women, followed by 9.0% among non-Hispanic black women, 10.7% among Hispanic women, and 7.9% among non-Hispanic white women. Compared with non-Hispanic white women, Asian women had 2.44 (95% confidence interval [CI], 1.81–3.29; P < .001) times the odds of having gestational diabetes, independent of maternal age, education, marital status, income, prenatal care adequacy, prepregnancy BMI, and physical activity. Acculturation was negatively associated with having gestational diabetes (odds ratio [OR] = 0.93; 95% CI, 0.86–0.99) and explained 15.9% (95% CI, 11.38%–25.08%; P < .001) of the association between Asian race and the condition.

Conclusion: We found that Asian race was an independent risk factor for gestational diabetes, and higher acculturation may play a protective role against it in Asian American women.


Gestational diabetes mellitus, one of the most common pregnancy complications, is defined as having any degree of glucose intolerance with onset of pregnancy.[1] Recent data showed a significant increase globally in the prevalence of the condition among women of various ethnic/racial backgrounds and in different geographic regions.[2,3] This trend is likely to continue because of the rise in obesity rates for women of reproductive age. Although most women return to normal glucose status after delivery, 20% of women with gestational diabetes develop impaired fasting glucose or impaired glucose tolerance 6 to 12 weeks postpartum.[4,5] More importantly, women with gestational diabetes are at increased risk of developing type 2 diabetes later in life. This increased risk has been documented in different populations and countries. On average, the risk of developing type 2 diabetes is 7.4 times greater for women with gestational diabetes than for women without.[4]

It is well documented that gestational diabetes prevalence is higher among Asian women than among non-Hispanic white, non-Hispanic black, or Hispanic women.[6] Articles published over the past 20 years with either population-based studies with sample size at or above 500 or hospital-based studies with sample size at or above 1,000 in which at least 70% of the population was screened showed that although the prevalence of gestational diabetes varied worldwide, the Southeast Asia region consistently had the highest prevalence.[6] Even in studies within 1 country such as the United States,[7–15] the United Kingdom,[16] Switzerland,[17] and Australia,[18] Asian women had the highest gestational diabetes rate among all racial/ethnic groups.

However, little data exist on why prevalence is highest among Asian women. Most previous studies that reported gestational diabetes prevalence among different racial/ethnic groups in the United States relied on birth certificate data,[13] insurance data,[14] or hospital discharge data,[15] which are known to be subject to missing data.[19] Moreover, earlier studies did not have detailed information on women's lifestyle, behavioral, and psychosocial factors or social support, acculturation, and neighborhood contextual factors.[14] Acculturation is the social process by which racial/ethnic minority people adopt the behaviors, practices, attitudes, and values of the host country.[20] Higher acculturation was associated with increased risk of diabetes among Hispanic populations in a US study[21] and among Chinese populations in an Australian study.[22] Because Asians are the largest and fastest-growing group of new immigrants to the United States, with approximately 74% foreign-born,[23] it is worth exploring how socio-cultural factors such as acculturation might play a role in these associations. Such information is critical for gaining better understanding of the underlying reasons why Asian women have the highest gestational diabetes prevalence globally and within a country.

We examined gestational diabetes prevalence by race/ethnicity and by subgroups of Asian women in a population-based study in Los Angeles County, California. We also examined whether the disparities in prevalence observed was independent of known risk factors such as maternal demographics (eg, age, education, marital status, income), prepregnancy body mass index (BMI) (weight in kg divided by height in square meters), adequacy of prenatal care, physical activity, stress during pregnancy, and neighborhood contextual factors. Furthermore, we assessed whether acculturation played a role in the association between race/ethnicity and gestational diabetes prevalence.