Gestational diabetes: influence of ethnic and economic determinants

Gestational diabetes: influence of ethnic and economic determinants
Gestational diabetes: influence of ethnic and economic determinants

The occurrence of gestational diabetes is a growing complication in public health. This metabolic complication linked to pregnancy is associated with numerous short and medium term complications. There are fewer studies describing the links between gestational diabetes and long-term maternal health, and the influence of women’s ethnic origin and socioeconomic level is little explored.

Analysis of data from more than 10,000 pregnant women

A British team carried out this work from the CPRD (Clinical Practice Research Datalink), an anonymized database of 18 million British patients, representative of the general population. In this study, all women diagnosed with gestational diabetes at 26e week of pregnancy between 2000 and 2018 were included, if at least 12 months of postpartum follow-up was available. The medical data of these women were analyzed throughout the available follow-up, in May 2019. Four main complications were sought: recurrence of gestational diabetes during a new pregnancy, type 2 diabetes, high blood pressure (hypertension) and depression.

In total, 10,868 women who had gestational diabetes were identified (mean age 32.5 years), including 69% women of Caucasian origin, 16.1% of South Asian origin and 4.9% of women of African origin. During the average follow-up of 5.4 years, 20.8% of them developed depression, 11.2% type 2 diabetes, 4.8% hypertension, and 61.4% of those having experienced a new pregnancy were again diagnosed with gestational diabetes.

A strong interaction between deprivation and ethnic origin

Apart from the influence of age and body mass index (BMI), the researchers described several associations of interest: the incidence of new gestational diabetes and that of hypertension were higher in women of African origin (incidence rate ratios 13.4 and 2.29 per 100 person-years respectively) than among women of Caucasian origin (incidence rate ratios 12.08 and 0.82 per 100 person-years), while women of Caucasian origin had a higher incidence of depression (4.67 versus 1.23 per 100 person-years).

Women of African origin thus had a higher risk of hypertension than women of Caucasian origin (hazard ratio adjusted (HRa): 2.93 [1,93 à 4,46]). Women of South Asian origin had a higher risk of type 2 diabetes compared to women of Caucasian origin. According to the authors, it is possible that the overrepresentation of depression among the latter is linked to an underdiagnosis in other groups of women.

The reduction in the socio-economic level of women accentuated the risk of occurrence of these different pathologies: for example, the most disadvantaged women also had twice the risk of developing hypertension (adjusted HR 2.19 [1,51 à 3,16]) than the least disadvantaged.

Unlike other international studies, this work does not confirm differences in the recurrence of gestational diabetes depending on the origin of the women. Furthermore, the impact of ethnic origin and socio-economic level on these different risks becomes statistically insignificant when they are combined, confirming a strong interaction between these two parameters. The analysis was limited by the fact that data on socio-economic level and ethnicity were not available for all regions of the UK.

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