ABSTRACT Objective To assess racial and ethnic differences in gestational diabetes mellitus (GDM) prevalence and perinatal outcomes among U.S. women with normal prepregnancy body mass index (BMI). Design, Setting, and Participants Retrospective, population‐based cohort study using 2021–2023 US National Vital Statistics System data. Included singleton live births to women aged 18–44 years with BMI 18.5–24.9 kg/m 2 . Exclusions were preexisting hypertension or diabetes, multiple gestations, missing covariates, or implausible data. Exposures Race/ethnicity: White, Black, Asian, and Other (Native American/Alaska Native, Native Hawaiian/Pacific Islander, and multiracial). Main Outcomes and Measures Primary outcome: GDM prevalence by race. Logistic regression estimated adjusted odds ratios (aORs) with White women as the reference. Secondary outcomes: preterm delivery macrosomia, NICU admission, and neonatal respiratory failure. Results A total of 3,754,684 women, GDM prevalence was highest in Asians (12.5%). Compared with White women, Asians had nearly threefold higher odds of GDM (aOR, 2.95; 95% CI, 2.91–3.00). GDM was associated with preterm delivery (aOR, 1.23; 95% CI, 1.22–1.25), NICU admission (aOR, 1.26; 95% CI, 1.24–1.28), and neonatal respiratory failure (aOR, 1.27; 95% CI, 1.22–1.32), in all racial groups. Macrosomia was increased only in Black (aOR, 1.55; 95% CI, 1.43–1.68) and Other (aOR, 1.21; 95% CI, 1.08–1.34). Conclusions Among women with normal BMI, substantial racial disparities in GDM prevalence and outcomes exist, with Asian women at the highest risk. Our results support earlier and ethnicity‐tailored GDM screening among women with normal BMI—particularly Asian women—plus proactive counseling on glucose monitoring and culturally adapted lifestyle interventions during pregnancy.
Zhu et al. (2025) studied this question.