The impact of educational attainment on the occurrence of gestational diabetes mellitus in two successive pregnancies of Finnish primiparous women: a population-based cohort study

Kristiina Rönö,Merja Kristiina Laine,Mika Gissler,Hannu Kautiainen,Senja Masalin,Johan Gunnar Eriksson

doi:10.1007/s00592-020-01517-5

Abstract

AimsTo assess the impact of educational attainment on the occurrence and recurrence of gestational diabetes mellitus (GDM) in two successive pregnancies in primiparous women.MethodsThis is a population-based observational cohort study including all 2347 Finnish women without previously diagnosed diabetes, aged ≥ 20 years from the city of Vantaa, Finland, who gave birth to their first and second child between 2009 and 2015. National registries provided data on study participants. We divided the population into four groups according to the presence of GDM in the two pregnancies (GDM−/−, n = 1820; GDM−/+, n = 223; GDM+/−, n = 113; GDM+/+, n = 191).ResultsThe occurrence of GDM in the first pregnancy was 13.0% (n = 304) and 17.6% (n = 414) in the second. The recurrence rate of GDM was 62.8%. The four groups did not differ in relation to educational attainment (p = 0.11). In multinomial regression analysis, educational attainment protected from GDM in the second pregnancy [relative risk ratio 0.93 (95% confidence interval (CI) 0.86–0.99) per year of schooling for being GDM−/+ compared with GDM−/−]. In multivariate logistics models, prepregnancy body mass index at the first pregnancy [odds ratio (OR) 1.53 per 1-standard deviation (SD) (95% CI 1.22–1.91)], first-born birth weight z-score [OR 1.30 per 1-SD (95% CI 1.00–1.67)], and inter-pregnancy weight change [OR 1.66 per 1-SD (95% CI 1.27–2.16)], but not educational attainment, predicted recurrence of GDM.ConclusionsThe recurrence rate of GDM was high. Education protected from novel GDM in the second pregnancy, but was not associated with GDM recurrence.

Highlights

Gestational diabetes mellitus (GDM) is a serious and increasing public health issue and a common pregnancy complication associated with adverse short- and long-term health outcomes for the woman and her offspring [1,2,3]
We have previously shown that within this cohort, income and education are inversely associated with the occurrence of gestational diabetes mellitus (GDM) in primiparous women [22]
According to our study findings, education protects from a novel occurrence of GDM in the second pregnancy, when the first pregnancy has not been complicated by GDM

Summary

Introduction

Participants and methodsGestational diabetes mellitus (GDM) is a serious and increasing public health issue and a common pregnancy complication associated with adverse short- and long-term health outcomes for the woman and her offspring [1,2,3]. Advancing age [6, 7], a family history of diabetes [7], and ethnicity of a non-Anglo-European decent [8] are well-established risk factors for GDM. Multiparity is associated with an increased risk of GDM [6], advancing maternal age and weight gain both during and between pregnancies seem to mediate the effect [9]. Both ethnicity and parity have a significant effect on the recurrence rate of GDM. Modifiable risk factors for the occurrence and recurrence of GDM are mostly lifestyle related, such as degree of adiposity [11, 12], excessive gestational weight gain [13], and inter-pregnancy weight gain [14, 15]

Results

Discussion

Conclusion