Socioeconomic status, maternal risk factors, and gestational diabetes mellitus across reproductive years: a Finnish register-based study

Abstract

IntroductionTo evaluate the degree to which socioeconomic differences in gestational diabetes mellitus (GDM) are accounted for by differences in maternal risk factors, to assess whether age-related risks of GDM differ across socioeconomic groups, and to identify priority populations for future interventions.Research design and methodsWe performed a register-based study using data from the Finnish Medical Birth Register and Statistics Finland on the 474 166 women who gave birth in Finland from 2008 to 2015. We collected information on GDM based on the International Classification of Diseases 10th Revision codes O24.4 and O24.9. We used multivariable models to examine the association between socioeconomic status, maternal risk factors, and GDM. We further tested interaction on multiplicative and additive scales.ResultsThe incidence of GDM was 8.7% in 2008–2011 and 12.5% in 2012–2015. Lower socioeconomic levels than upper level employees were associated with an increased risk of GDM. Up to 64.0% of socioeconomic differences in GDM were attributed to body mass index and 5.5% to smoking. There was evidence for effect modification. Relative to women in the upper level category who were aged less than 19 years, GDM adjusted ORs (95% CIs) for women 35 years or older in upper level versus long-term unemployed groups were 3.28 (2.08–5.18) and 5.29 (3.35–8.35), respectively.ConclusionsThere is a paradox that socioeconomic advantage increases the incidence of GDM at the population level while reducing the incidence of GDM within the population. Nevertheless, socioeconomic differences in GDM persist and widen with increasing maternal age, even after accounting for maternal risk factors.

Maternal diabetes and risk of attention-deficit/hyperactivity disorder in offspring in a multinational cohort of 3.6 million mother–child pairs

“…Covariates were selected based on known confounders for the study association and risk factors for the study outcomes 30 , 42 – 50 , including demographic factors such as maternal age 47 , 51 – 53 , infant sex (as directly recorded by clinicians) 54 , socioeconomic status 55 , 56 , birth year, multifetal pregnancies 57 and other maternal factors including smoking 44 , 47 , 58 , 59 , alcohol consumption 47 , 60 , 61 , psychiatric and neurological conditions 47 , 48 , 62 – 64 , other chronic medical conditions (hypertension 51 , 65 , renal disease, inflammatory bowel disease 66 , 67 , autoimmune disease 46 , 68 , 69 , thyroid disorders 43 , 47 , 70 , 71 and polycystic ovary syndrome 45 , 72 , 73 ), BMI 44 , 47 , 51 , 74 and use of psychotropic medication 42 , 47 , 49 , antihypertensives, ADHD medication and known or suspected teratogenic medication. Various measures were applied as the proxy of socioeconomic status for each data source according to their respective practice (namely, median household income in Hong Kong, education level in Nordic countries, insurance fees in Taiwan and deprivation quintile in New Zealand).…”