Racial and Ethnic Differences in Gestational Diabetes: Time to Get Serious

During pregnancy, profound metabolic changes may reveal a predisposition toward glucose intolerance, manifesting as gestational diabetes. Gestational diabetes increases the risk of adverse pregnancy outcomes, including macrosomia, preeclampsia, birth trauma, and neonatal hypoglycemia. Notably, this diagnosis has implications that outlast pregnancy. Estimates from systematic reviews suggest a markedly elevated risk of future diabetes in people with gestational diabetes, with as many as 50% to 70% of affected individuals developing overt diabetes later in life. In addition, individuals with a history of gestational diabetes have a higher risk of future cardiovascular disease compared with those who do not develop this common pregnancy complication. In the context of an ongoing epidemic of diabetes in the general population,6 the findings by Shah and colleagues reported in this issue of JAMA are particularly concerning: gestational diabetes rates among nulliparous women have increased in the US.