Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review

Figures & data

Table 1. Comparison of BMI in pregnant women between groups of Asian and African origin and the majority population in European countries

Author, year, (reference number)	Study design	Study population	Variable	Ethnic groups	n	Results		Comments
Djelantik et al. 2012 39	Community-based cohort study	Pregnant women living in Amsterdam, the Netherlands, January 2003–March 2004	Pre-pregnant BMI (pBMI)	N Dutch African Turkish Moroccan Other non-Western Other Western	7,871 4,900 495 328 585 904 659	pBMI 25–30 13.7% 30.9% 22.7% 33.4% 21.3% 11.1%	pBMI>30 4.1% 18.0% 11.0% 12.7% 7.9% 3.5%	Self-reported height and weight. pBMI>30 significantly more frequent among Turkish, Moroccan, and women of African descent
Jenum et al. 2012 41	Population-based cohort study	Healthy, pregnant women from three city district of Oslo, Norway, May 2008–2010	Pre-pregnant BMI (pBMI)	N Western Europe South Asia East Asia Middle East Somalia Sub-Saharan Africa/other non-Western	823^a 313 188 39 112 35 30	pBMI. Mean (SD) 24.6 (4.8) 23.7 (4.1) 22.3 (3.4) 25.9 (5.1) 26.8 (6.5) 26.3 (6.5)		Self-reported pre-pregnant weight, measured height at first visit. Heterogeneity between groups.
Hestlehurst et al. 2010 37	Database study	Women attending 37 maternity units in UK, 1989–2007	Early pregnant BMI	N White Asian/Asian British Black/Black British Mixed Chinese or other ethnic groups	619,323 447,423 50,738 22,525 5,962 11,394	BMI 25–29.9 24.7% 25.6% 32.3% 23.5% 20.5%	BMI>30 13.7% 10.4% 20.6% 12.7% 7.6%	Maternal height and weight at initial GP appointment, adjusted for gestational age. The study population was found to be nationally representative. Black/Black British had significantly higher ORs for overweight and obesity (Reference: White. Adjusted for age, parity, employment, and deprivation).
Ochsenbein-Kölble et al. 2007 48	Prospective cross-sectional study	Nulliparous women attending an obstetric prenatal outpatient clinic, Zürich, Switzerland, January 1996–February 2000	Pre-pregnant BMI (pBMI)	N Caucasians Asians Blacks	4,034 3,242 578 214	pBMI. Mean (SD) 23.6 (4.5) 22.5 (3.9) 24.1 (4.3)		Self-reported pre-pregnant weight. Mean pBMI sign different in Asians, but not in Blacks, compared to Caucasians.
Loetscher et al. 2007 40	Retrospective cohort study	Nulliparous women attending a prenatal outpatient clinic, Zürich, Switzerland, 1999–2003	Pre-pregnant BMI (pBMI)	N Switzerland Turkey Sri Lanka Middle East South Asia Far East Africa	1,432^a 262 95 173 24 36 36 118	pBMI>25 22.9% 42.1% 34.1% 41.7% 19.4% 2.8% 50.0%	pBMI>30 8.0% 16.8% 4.6% 8.3% 2.8% 0.0% 16.1%	Self-reported pre-pregnant weight, measured height at first visit. No analyses on differences in pre-pregnant BMI across ethnic groups were presented.
Hestlehurst et al. 2006 38	Database study	Women attending a maternity unit, Middlesbrough, UK, 1990–2004	Early pregnant BMI	N Caucasian Mixed race Asian/Asian British Black/Black British Chinese/other Ethnic group unknown	36,821 33,420 187 1,486 77 133 1,058	BMI 25–29.9 23.8% 18.2% 23.4% 28.6% 14.3% 24,1%	BMI>30 10.8% 11.2% 9.5% 10.4% 6.8% 11.2%	Maternal height and weight at initial GP appointment, adjusted for gestational age. Ethnicity was not significantly associated with obesity in models adjusted for age, parity, employment, deprivation, and marital status.

^aResults from women of other European and American nationalities not reported in this table.

Table 2. Comparison of gestational weight gain and post-partum weight retention between groups of Asian and African origin and the majority population in European countries

Author, year, (reference number)	Study design	Study population	Variable	Groups by ethnicity	n	Results	Comments
Ochsenbein-Kölble et al. 2007 48	Prospective cross-sectional study	Nulliparous women attending an obstetric prenatal outpatient clinic, Zürich, Switzerland, January 1996–February 2000	BMI and weight gain centile curves during the pregnancy	N Caucasians Asians Blacks	4,034 3,242 578 214	Asians and Blacks had significantly lower weight gain than Caucasians over the whole pregnancy period (p<0.001).	Self-reported pre-pregnant weight. Weight measured at each antenatal visit. Absolute weight change not presented.
Loetscher et al. 2007 40	Retrospective cohort study	Nulliparous women attending a prenatal outpatient clinic, Zürich, Switzerland, 1999–2003	Gestational weight gain	N Switzerland Turkey Sri Lanka Middle East South Asia Far East Africa	1,432^a 262 95 173 24 36 36 118	Mean (SD) net weight gain 10.9 (6,0) 11.6 (7,5) 8.4 (5,2) 11.3 (5.3) 10.3 (4.6) 11.6 (5.2) 9.0 (7.1)	Self-reported pre-pregnant weight. Weight at delivery (within 1 week prior to delivery) measured at the hospital No analyses on differences in weight gain across ethnic groups were presented.
van Poppel et al. 2012 82	Prospective cohort study	Pregnant women attending antenatal care in Amsterdam, the Netherlands, January 2003–March 2004	Weight retention 3–5 months post-partum	N Dutch Surinamese Turkish Moroccan Ghanaian	4,212^a 2,601 231 171 172 42	Weight retention>5 kg 26% 27% 52% 33% 26%	Self-reported pre-pregnant weight and weight 3–5 months post-partum. Turkish women had significantly higher crude OR for weight retention>5 kg (Reference: Dutch)

^aResults from women of other European and American nationalities not reported in this table.

Table 3. Comparison of the risk of gestational diabetes mellitus (GDM) between groups of Asian and African origin and the majority population in European countries

Author, year, (reference number)	Study design	Study population	Variable	Ethnic groups	n	Results		Comments
Jenum et al. 2012 41	Population-based cohort study	Healthy, pregnant women, living in three city district of Oslo, Norway, 2008–2010	GDM with WHO criteria	N Western Europe (ref) South Asia Middle East Other minorities	759 313 188 112 146	Crude prevalence 13% 11% 15% 17% 12%	AOR p=0.026 – 2.24 (1.26–3.97) 2.13 (1.12–4.08) 1.45 (0.77–2.73)	AOR: adjusted OR, adjusted for age, pre-pregnant BMI, parity
			GDM with modified IADPSG criteria (no 1-h glucose values)	N Western Europe South Asia Middle East Other minorities	759 313 188 112 146	Crude prevalence 32% 24% 42% 37% 30%	AOR p<0.001 (ref) 2.94 (1.94–4.47) 1.79 (1.10–2.93) 1.44 (0.91–2.28)	AOR: adjusted OR, adjusted for age, pre-pregnant BMI, parity
Khalil et al. 2012 62	Cohort study	Pregnant women in 3 hospitals in South England, UK	Diagnosis with modified WHO criteria (fasting plasma glucose≥6.0 mmol/l)	N Caucasian Afro-Caribbean South Asian East Asian Mixed	76,158 57,564 11,395 3,645 1,793 1,761	1,355 cases (1.8%)^a,b	Crude OR (ref) 1.89 (1.66–2.16) 2.31 (1.90–2.80) 2.26 (1.72–2.96) 1.18 (0.81–1.70)	Data collected as part of routine antenatal care. GDM screening by 2-step approach
Makgoba et al. 2011 63	Retrospective study	Pregnant women in 15 maternity units in North West London, UK, 1988–2000	GDM criteria not specified. Reported by midwives at delivery. Inconsistency in methods and diagnosis	N White European, Black African, Black Caribbean South Asian Other minorities	174,320 131,201 4,927 4,698 20,086 13,408	Crude prevalence 1.0% 0.7% 1.8% 1.1% 2.0% 2.0%	Crude OR* (ref) 2.62 (1.83–3.74) 1.21 (0.72–2.02) 3.00 (2.51–3.57)	Advancing maternal age and BMI was associated with significantly higher risk for risk for GDM in South Asian and Black African women than in White European

^aFigures calculated based on number of cases reported in the paper.

^bFigures in subgroups not reported.

*For the BMI group: 18.5–24.9.

Table 4. Comparison of the risk of pre-eclampsia for groups of Asian and African origin and the majority population in European countries

Author, year, (reference number)	Study design	Study population	Variable	Ethnic groups	n	Results		Comments
Khalil et al. 2012 62	Prospective cohort study	Pregnant women in 3 hospitals in South England, UK	Pre-eclampsia, defined affording to International Society for the Study of Hypertension in Pregnancy (ISSHP)	N Caucasian Afro-Caribbean South Asian East Asian Mixed	76,158 57,564 11,395 3,645 1,793 1,761	1,698 cases (2.3%)^a,b	Unadjusted OR (ref) 2.91 (2.62–3.24) 1.58 (1.28–1.95) 1.03 (0.72–1.47) 1.23 (0.89–1.72	Data collected as part of routine antenatal care. Number of cases in subgroups not reported. Significantly higher OR for pre-eclampsia in Afro-Caribbean and South Asian than Caucasian women
Bouthoorn et al. 2012 78	Population-based prospective cohort study	Pregnant women, The Generation R Study, Rotterdam, the Netherlands, 2002–2006	Pre-eclampsia, defined according to ISSHP	N Dutch Turkish Moroccan Cape Verde Surinamese-Creole^c Surinamese-Hindustan	6,215 3,886 718 534 331 232 250	120 cases (2.1%)^a 1.9% 1.6% 0.8% 4.2% 2.4% 3.8%	Unadjusted OR (ref) 0.83 (0.44–1.57) 0.40 (0.14–1.10) 2.22 (1.22–4.07) 1.24 (0.5–3.11) 2.04(1.00–4.13)	4–11% missing values for hypertensive pregnancy complications in ethnic groups

^aFigures calculated based on number of cases reported in the paper.

^bFigures in subgroups not reported.

^cResults for the Surinamese, who are reported to have at least partly African (the Creoles) and Indian (the Hindustanis) ancestral origin are given in this table, but not for women from the Antilles.

Table 5. Comparison of differences in birth weight for groups of Asian and African origin and the majority population in European countries

Author, year, (reference number)	Study design	Study population	Variable	Ethnic groups	n	Results	Comments
Goedhart, 2008 122	Population-based cohort study	Singleton, live births born in Amsterdam, the Netherlands, Jan 2003–March 2004.	Birth weight	N Dutch Turkish Moroccan Ghanaian (African) Other minorities	7,118^a 3,859 361 629 137 2,123	Mean birth weight 3,548 g 1st gen: 3,469 g 2nd gen:3,429 1st gen: 3,527 g 2nd gen:3,419 g 3,366 g	All ethnic groups had lower mean birth weight for gestational age compared with the native Dutch.
Kelly et al. 2008 123	Population-based cohort study	A random sample of all births in England and Wales, 2000–2001.	Birth weight	N British White India Pakistan Bangladesh Black African Other minorities	17,769^a 14,068 433 687 215 327 2,339	Mean birth weight 3,416 g 3,072 g 3,110 g 3,089 g 3,343 g	Bangladeshi neonates were on average 327 g lighter than British whites. Indians 344 g, Pakistanis 306 g, and Black African 73 g lighter.
Moser et al. 2008 124	Population-based register study	All live births in England and Wales, UK, 2005	Birth weight	N British White India Pakistani Bangladesh Black African Other minorities	649,371^a 418,052 16,053 24,290 8,241 3,535 179,200	Mean birth weight 3,393 g 3,082 g 3,130 g 3,075 g 3,288 g
Harding, 2006 127	Population-based register study	Hospital records from two municipalities in Lisbon, Portugal, July 2001–June 2002	Birth weight	N Native Portuguese Foreign-born African Portugal-born African	3,918 2,744 750 424	Mean birth weight 3,252 g 3,307 g 3,232 g	Term neonates of foreign-born African mothers were slightly heavier than White Portuguese neonates, but this difference disappeared after basic adjustments.
Drooger, 2005 128	Population -based cohort study	‘The Generation R study’ (low-risk pregnancies), Rotterdam, the Netherlands (data collection from 2002).	Estimated foetal weight (by ultrasound at GW 40)	N Native Dutch Moroccan Turkish Cape Verdean Other minorities	1,494 741 53 66 30 604	Mean birth weight 3,519 g 3,447 g 3,389 g 3,210 g	Differences not significant in Moroccan neonates or in Turkish neonates after adjustments for maternal height/weight, parity, and gender.
Harding, 2005 125	Population-based register study	National birth data from Portugal 1995–2002, for two ethnic groups.	Birth weight	N Portuguese African	872,463 849,595 22,463	Mean birth weight 3,303 g 3,297 g	No difference in mean birth weight in the two groups.
Vahratian, 2004 129	Population-based register study	Births at three public hospital prenatal clinics in Belgium, May 1994–April 1995.	Birth weight	N Native Belgians North African	1,162 808 354	Mean birth weight 3,184 g 3,338 g	Neonates born by North African immigrants were 154 g heavier than native Belgians, but this difference disappeared when adjusting for gestational age.
Harding, 2004 126	Population-based register study	One percent of all births in England and Wales, 1983–2000.	Birth weight	N British White UK-born Indian Foreign-born Indian UK-born Pakistani Foreign-born Pakistanis UK-born Bangladeshi Foreign-born Bangladeshi UK-born Black African Foreign-born Black African Other minorities	57,674^a 52,554 491 1,297 417 1,121 99 896 75 224 300	Mean birth weight 3,400 g 3,033 g 3,066 g 3,110 g 3,123 g 3,026 g 3,110 g 3,167 g 3,302 g	All groups had significantly lower mean birth weight, compared with British White neonates. After adjustments for maternal factors, mean birth weights were similar in neonates born by UK-born and foreign-born mothers within these ethnic groups.
Vangen, 2002 130	Population-based register study	All births in Norway from 1980–1995 for four ethnic groups	Birth weight	N Norwegian Pakistani Vietnamese North African Other minorities	820,256 808,658 6,854 3,283 1,461	3,530 g 3,244 g 3,202 g 3,559 g	Neonates born by Pakistani mothers were 286 g lighter, Vietnamese 328 g lighter, and North African 29 g heavier than neonates born by Norwegian mothers.

^aResults from women of other European and American nationalities not reported in this table.

Search terms with regard to ethnic differences in the pre-pregnant BMI, gestational weight gain, post-partum weight retention, prevalence of gestational diabetes mellitus, prevalence of pre-eclampsia, and birth weight and body composition of neonates.

	Search terms
Table No, outcome	Main area	Demarcations		Joint search string
1: pre-pregnant weight	Body constitution	(Pregnant OR pregnancy)	Europe	(Human migration OR Africa OR Asia OR ethnic OR ethnicity OR race OR racial OR immigrant OR immigrants OR minority OR minorities OR ethnology)
2: gestational weight gain	Weight gain	(Pregnant OR pregnancy)	Europe
2: post-partum weight retention	Postpartum weight retention	(Pregnant OR pregnancy)	Europe
3: gestational diabetes mellitus	Diabetes, gestational	(Pregnant OR pregnancy)	Europe
4: pre-eclampsia	Pre-eclampsia	(Pregnant OR pregnancy)	Europe
5: birth weight	(Birth weight OR birth weight OR body composition OR fat OR lean OR thin)	(Newborn OR infant OR neonatal)	Europe	(Ethnology OR ethnic OR ethnicity OR race OR racial OR minorities OR groups, minority)

Filters: 10 years, English.

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