Gestational diabetes care and outcomes for refugee women: a population‐based cohort study

Khan, Sumsullah; Yao, Zhan; Shah, Baiju R.

doi:10.1111/dme.13440

Cited by 20 publications

(22 citation statements)

References 23 publications

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“…In our sample, results were particularly strong for labour immigrants, but family immigrants, immigrant students, refugees, and immigrants from other Nordic countries also exhibited lower overall incidence of preeclampsia compared with Norwegian women. Our results regarding a lower overall incidence of preeclampsia in refugees agree with two recent studies comparing refugee pregnant women with Turkish and Canadian-born pregnant women [ 24 , 25 ]. A comparison of results with studies concerning other immigration reasons was difficult due to the scarce literature.…”

Section: Discussionsupporting

confidence: 92%

Preeclampsia by maternal reasons for immigration: a population-based study

Nilsen

Vik

Rasmussen

et al. 2018

BMC Pregnancy Childbirth

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BackgroundTo investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration.MethodsWe included 1,287,270 singleton pregnancies (163,508 to immigrant women) in Norway during 1990–2013. Individual data were obtained through record linkage between the Medical Birth Registry of Norway and Statistics Norway. Analyses were performed for preeclampsia overall and in combination with preterm birth < 37 and < 34 weeks of gestation, referred to as preterm and very preterm preeclampsia. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard errors, adjusted for relevant covariates, including maternal income and education.ResultsPreeclampsia was reported in 3.5% of Norwegian women and 2.5% of immigrants. Compared with Norwegian women, the adjusted OR for preeclampsia was lowest in labour immigrants (adjusted OR 0.55 [95% CI 0.49–0.62]), followed by family immigrants (0.62 [0.59–0.65]), immigrant students (0.75 [0.65–0.86]), refugees (0.81 [0.75–0.88]), and immigrants from other Nordic countries (0.87 [0.80–0.94]). Compared with Norwegian women, labour immigrants also had lower adjusted odds of preterm and very preterm preeclampsia, whereas refugees had increased adjusted odds of preterm and very preterm preeclampsia (< 37 weeks: 1.18 [1.02–1.36], and < 34 weeks: 1.41 [1.15–1.72]).ConclusionsThe occurrence of preeclampsia was lower overall in immigrants than in non-immigrants, but associations varied by maternal reasons for immigration. Maternity caregivers should pay increased attention to pregnant women with refugee backgrounds due to their excess odds of preterm preeclampsia.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2034-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Preeclampsia by maternal reasons for immigration: a population-based study

Nilsen

Vik

Rasmussen

et al. 2018

BMC Pregnancy Childbirth

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“…On the basis of the present data, it can be assumed that women with a migrant background are overrepresented in that area as well. This is particularly worrying, as migrants have an increased risk of developing diabetes mellitus after GDM [28]. Improving this situation should be a goal for all health-care professionals involved in pregnancy care.…”

Section: Discussionmentioning

confidence: 99%

The participation rate of migrant women in gestational diabetes screening in Austria: a retrospective analysis of 3293 births

Weiss

Oppelt²,

Mayer³

2018

Arch Gynecol Obstet

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Purpose This study evaluated the extent to which migrant women participate in the mandatory oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM) screening in Austria. Methods A retrospective data analysis was carried out of births at an obstetrics unit in a university hospital between January 2013 and December 2015. The inclusion criteria were singleton pregnancies, live births, birth weight ≥ 3500, and no preexisting diabetes mellitus. The patient’s extramurally obtained OGTT values and history of GDM were checked. If the mother’s country of birth was not Austria, the woman was classified as a migrant. Three groups were defined: group 1—women with normal OGTT; group 2—women with pathological OGTT; and group 3—women without OGTT or with an incomplete OGTT. Main outcome measures: Numbers of complete and incomplete OGTTs and rate of women with pathological OGTTs not treated in accordance with the guidelines among mothers born in Austria or migrants. The groups were compared using the t -test, chi-squared test, or Fisher’s exact test. Results A total of 3293 births met the inclusion criteria, and 43.52% of all mothers were migrants; 16.8% of all women had pathological OGTT findings. Only 60.1% of the latter received treatment in accordance with the guidelines. The proportion of mothers born in Austria who did not have OGTTs, or only incomplete ones, was 5.4%. In the group of migrant women, the corresponding figure was 10.5% ( P < 0.01). Conclusions Migrant women have significantly lower rates of participation in GDM screening.

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“…In addition to their sometimes traumatic experiences before emigrating from their home country, they often have lower socioeconomic status in their new country and they sometimes have a higher parity. However, in a Canadian study, there was a lower frequency of adverse outcomes during GDM pregnancy among refugees than among non‐immigrants . Another study reports that in Norway it is predominately the women from Somalia who have poorer pregnancy outcome compared with native Norwegians …”

Section: Introductionmentioning

confidence: 94%

“…However, in a Canadian study, there was a lower frequency of adverse outcomes during GDM pregnancy among refugees than among non-immigrants. 18 Another study reports that in Norway it is predominately the women from Somalia who have poorer pregnancy outcome compared with native Norwegians. 19 In recent years, we have started using metformin as a first line of treatment, especially in overweight women.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcome in women with gestational diabetes – A longitudinal study of changes in demography and treatment modalities

Moll

Landin‐Olsson

Nilsson

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Gestational diabetes is on the rise and demographics are changing in many countries due to increased migration. Simultaneously, the treatment of gestational diabetes in our clinic has shifted towards metformin with substantially less insulin treatment. The aim was to study the impact of these changes on metabolic control and pregnancy outcome by comparing women diagnosed with gestational diabetes during 2012‐2013 and 2016‐2017. Material and methods Our universal Oral Glucose Tolerance Test screening program for gestational diabetes diagnosed 199 women with singleton pregnancies during 2012‐2013 and 203 during 2016‐2017. Treatment and achieved metabolic control in the two different time periods were compared. Pregnancy outcome data related to gestational diabetes were retrieved from case notes and compared between the different time periods. Results When comparing results from 2016‐2017 with 2012‐2013 there was no difference in maternal weight or weight gain. There was a higher frequency of heredity (52.6 vs 35.4%; P = 0.001) and non‐Scandinavian ethnicity (46.5 vs 33.8%; P = 0.011).The frequency of smoking during pregnancy was significantly lower (2.6 vs 7.7%; P = 0.023) There was an improved metabolic control as measured by median glucose in 2016‐2017 compared with 2012‐2013 (5.8 vs 6.2 mmol/L; P < 0.001). Insulin was less frequently used in 2016‐2017 than in 2012‐2013 (32.5 vs 44.7%; P = 0.012). There was a significant increase in the use of metformin (14.8 vs 0%; P < 0.001). There were no differences regarding the frequency of large‐for‐gestational‐age infants (8.2% vs 7.3%; P = 0.762) or macrosomia (16.3 vs 15.1%; P = 0.745), median birthweight (3510 vs 3521; P = 0.879), frequency of cesarean section (28.1 vs 27.8%; P = 0.951) or Apgar scores at 10 minutes (10 [3‐10] vs 10 [7‐10]; P = 0.290). Conclusions In an increasing but changing population of gestational diabetes women in our region, with more hereditary and non‐Scandinavian origins, but with fewer smokers, metabolic control has improved with maintained favorable pregnancy outcomes, with more frequent use of metformin and substantially less use of insulin treatment.

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Gestational diabetes care and outcomes for refugee women: a population‐based cohort study

Cited by 20 publications

References 23 publications

Preeclampsia by maternal reasons for immigration: a population-based study

Preeclampsia by maternal reasons for immigration: a population-based study

The participation rate of migrant women in gestational diabetes screening in Austria: a retrospective analysis of 3293 births

Pregnancy outcome in women with gestational diabetes – A longitudinal study of changes in demography and treatment modalities

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