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Based on this epidemiologic study, we found ethnic and geographic variations in the prevalence of gestational diabetes mellitus. The lowest rate was found in Koreans living in Korea while the highest was seen in immigrant Koreans living in Chicago. The more than 2 fold difference seen between Seoul and Suwon studies might be related to the bias in patient selection in the Ajou university hospital. Furthermore, we found a significant increase in the GDM rates in immigrant Koreans, indicating environmental effects as the key risk factor.