Retrospective cohort study of the association between socioeconomic deprivation and incidence of gestational diabetes and perinatal outcomes

Abstract

Introduction: Socioeconomic disparities have been shown to correlate with perinatal mortality and the incidence of type 2 diabetes. Few studies have explored the relationship between deprivation and the incidence of gestational diabetes (GDM). We aimed to identify the relationship between deprivation and incidence of GDM, after adjusting for age, BMI, and ethnicity. We also examined for relationships between deprivation and perinatal outcomes.

Methods: A retrospective cohort analysis of 23,490 pregnancies from a major National Health Service Trust in Northwest London was conducted. The 2019 English Indices of Multiple Deprivation was used to identify the deprivation rank and decile for each postcode. Birthweight centile was calculated from absolute birthweight after adjusting for ethnicity, maternal height, maternal weight, parity, sex and outcome (live birth/stillbirth). Logistic regression and Kendall's Tau were used to identify relationships between variables.

Results: After controlling for age, BMI & ethnicity, Index of Multiple Deprivation postcode decile was not associated with an increased risk of developing gestational diabetes. Each increase in decile of deprivation was associated with an increase in birthweight centile by 0.471 (p < 0.001). After adjusting for confounders, age was associated with a 7.1% increased GDM risk (OR: 1.076, p < 0.001); BMI increased risk by 5.81% (OR: 1.059, p < 0.001). There was no significant correlation between Index of Multiple Deprivation rank and perinatal outcomes.

Discussion: Our analysis demonstrates that socioeconomic deprivation was not associated with incidence of GDM or adverse perinatal outcomes. Factors such as genetic predisposition and lifestyle habits may likely play a larger role in the development of GDM compared to socioeconomic deprivation alone.

Keywords: Birthweight centile; Deprivation; Gestational diabetes mellitus; Perinatal outcomes.

Fig. 1

The domains and weightings which constitute the 2019 Index of Multiple Deprivation (IMD2019) Produced by Srirangan Jeyaparam, 2022. Additional information can be obtained from the U.K. Ministry of Housing, Communities and Local Government's website: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/835115/IoD2019_Statistical_Release.pdf The U.K. Ministry of Housing, Communities and Local Government assigns Lower Layer Super Output Areas (LSOAs), which are small areas that constitute England and Wales, each with an average population of approximately 1500, a deprivation score using the IMD2019. This score is derived from 39 undisclosed indicators which are grouped into the above 7 domains of deprivation. These scores are then used to rank each LSOA nationally

Fig. 2

Flow chart showing inclusion process of the study 26063 records were extracted from the electronic health record system (Cerner). Records with any missing or misentered data in our required variables were removed from the dataset. Similarly, patients without a fixed address were also removed from the dataset. Late miscarriages (<24 weeks gestation) were also removed, leaving 23490 records for analysis

Fig. 3

A Table and B Forest plot showing adjusted odds ratios from multiple logistic regression model Multiple logistic regression analysis was conducted with the above variables. There was no significant difference in odds between any of the postcode deprivation deciles (as determined by IMD2019), and their odds of developing GDM, compared to decile 10 (least deprived decile). Age and BMI independently increased odds of developing GDM. Similarly, only women from the following ethnic groups had significantly higher odds of developing GDM compared to White British women: White- Other, Middle Eastern, Mixed- White and Asian, Black- African, Asian- Pakistani, Asian- Indian, Asian- Bangladeshi and Asian- Other