Is there a socioeconomic gradient in the prevalence of gestational diabetes mellitus?
ABSTRACT Previous studies have shown an association between Type 2 diabetes and lower socioeconomic status. This link is less clear in those with gestational diabetes mellitus (GDM). We test for a socioeconomic gradient in the prevalence of GDM by analysing data on 9,842 pregnant women who were offered testing for GDM in the Atlantic Diabetes in Pregnancy universal screening programme. A bivariate probit model relating GDM prevalence to socioeconomic status was estimated, controlling for variation in screening uptake rates across socioeconomic groups. The estimated increased prevalence of GDM is 8.6% [95% CI 2.7%-12.0%] for women in the lowest socioeconomic group when compared to the highest, suggesting a strong socioeconomic gradient in the prevalence of GDM. This gradient is found to be driven by differences in personal, clinical and lifestyle factors across socioeconomic groups.
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ABSTRACT: The aim of this population-based study was to assess the association between objectively recorded physical activity (PA) in early gestation and gestational diabetes mellitus (GDM) identified at 28 weeks of gestation in a multi-ethnic cohort of healthy pregnant women in Oslo, Norway. In total, 759 women were included. In early gestation (<20 weeks), light-, moderate-, and vigorous-intensity PA and number of steps were objectively recorded (SenseWear™ Armband Pro3), and self-reported PA, demographics, and anthropometrics were collected. The 75-g oral glucose tolerance test was performed at 28 weeks of gestation. Women with GDM had fewer objectively recorded steps (mean 7964 steps/day vs 8879 steps/day, P < 0.001) and minutes of moderate-to-vigorous-intensity PA (median 62 min/day vs 75 min/day, P = 0.004) in early gestation than women without GDM. Additionally, 30% of women with GDM compared with 44% (P < 0.001) of women without GDM self-reported regular PA before pregnancy. The significant inverse association between objectively recorded steps per day in early gestation and GDM persisted after adjustment for ethnic origin, weeks of gestation, age, parity, pre-pregnancy BMI, early life socioeconomic position, and self-reported regular PA before pregnancy. The adjusted odds ratio for GDM decreased 19% per standard deviation (3159 steps) increase in objectively recorded steps per day (P = 0.039). Daily life PA in early gestation measured as steps/day was associated with lower risk of GDM.Scandinavian Journal of Medicine and Science in Sports 02/2014; 24(5). DOI:10.1111/sms.12183 · 3.17 Impact Factor
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ABSTRACT: AimsWe examined the association between socio-demographic marginalization and plasma glucose levels at diagnosis of gestational diabetes in a multi-ethnic and socio-economically diverse patient group.Methods Medical charts at a Toronto gestational diabetes clinic were reviewed for women with a recorded pregnancy between 1 March 2006 and 26 April 2011. One-hour 50-g glucose challenge test values and postal code data were abstracted. Postal codes were merged with 2006 Canadian census data to compute neighbourhood-level ethnic concentration (% recent immigrants, % visible minorities) and material deprivation (% low education, % low income, single-parent households). We compared women in the highest neighbourhood quintiles for both ethnic concentration and material deprivation with all other women to explore an association between marginalization and diagnostic glucose levels. Multivariate regression models of glucose challenge test values and insulin prescription were adjusted for age, prior gestational diabetes, parity and diabetes family history.ResultsAmong 531 patients with complete glucose challenge test data (mean 11.94 mmol/l, sd 1.83), those in the most marginalized neighbourhoods had 0.43 mmol/l higher glucose challenge test values (95% CI 0.08–0.78) compared with the rest of the study population. Other factors associated with higher glucose challenge test values were prior gestational diabetes (0.59-mmol/l increment, 95% CI 0.19–0.99) and diabetes family history (0.32-mmol/l increment, 95% CI –0.01 to 0.66). Each additional 1 mmol/l glucose challenge test result was associated with an increased likelihood of being prescribed insulin (odds ratio 1.33, 95% CI 1.17–1.51).Conclusions Women living in the most materially deprived and ethnically concentrated neighbourhoods have higher glucose levels at diagnosis of gestational diabetes. They may need close monitoring for timely initiation of insulin.This article is protected by copyright. All rights reserved.Diabetic Medicine 06/2014; 31(12). DOI:10.1111/dme.12529 · 3.06 Impact Factor