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Does charge-free screening improve detection of gestational diabetes in women from deprived areas: a cross-sectional study

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ABSTRACT

Background: Gestational diabetes mellitus (GDM) occurs in 2–6 % of all pregnancies. We investigated whether area level deprivation is associated with a higher risk for GDM and whether GDM detection rates in deprived regions changed after the introduction of charge-free GDM screening in Germany in 2012.

Methods: We analyzed population-based data from Bavaria, Germany, comprising n = 587,621 deliveries in obstetric units between 2008 and 2014. Area level deprivation was assessed municipality-based using the Bavarian Index of Multiple Deprivation (BIMD), divided into quintiles and assigned to each mother based on her residential address. We estimated annual odds ratios (ORs) for GDM diagnosis by BIMD quintile with adjustment for maternal obesity, maternal age, migration background and single mother status.

Results: Women from the most deprived regions were less likely to be diagnosed with GDM before introduction of charge-free GDM screening (OR = 0.76 [95 % confidence interval: 0.66, 0.86] compared to least deprived areas), in 2008. In contrast, high area level deprivation was associated with significantly increased risk of GDM diagnosis in 2013 (OR [95 % confidence interval] = 1.15 [1.02, 1.29]). The OR was also elevated, although not significantly, in 2014 (OR [95 % confidence interval] = 1.05 [0.93, 1.18]).

Conclusions: The prevalence of GDM seems to have been underreported in women from highly deprived areas before introduction of the charge-free GDM screening in Germany. In fact, women living in deprived regions seem to have an increased risk for GDM and may profit from access to charge-free GDM screening.

No MeSH data available.


Related in: MedlinePlus

Yearly rates of gestational diabetes mellitus (GDM) diagnoses from 2008 to 2014 (numbers of pregnancies without pre-gestational diabetes in brackets) in Bavaria, Germany, by deprivation quintiles (Q1-Q5, plot a), and yearly odds ratios with corresponding 95 % confidence intervals for Q5 compared to reference Q1 (plot b, all estimates adjusted for maternal obesity, age, migration background and single mother status). In 2011, the criteria for GDM diagnosis were revised in Germany following WHO recommendations. In 2012, charge-free GDM screening, following a two-step procedure, was established in Germany
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Fig1: Yearly rates of gestational diabetes mellitus (GDM) diagnoses from 2008 to 2014 (numbers of pregnancies without pre-gestational diabetes in brackets) in Bavaria, Germany, by deprivation quintiles (Q1-Q5, plot a), and yearly odds ratios with corresponding 95 % confidence intervals for Q5 compared to reference Q1 (plot b, all estimates adjusted for maternal obesity, age, migration background and single mother status). In 2011, the criteria for GDM diagnosis were revised in Germany following WHO recommendations. In 2012, charge-free GDM screening, following a two-step procedure, was established in Germany

Mentions: The rate of GDM diagnosis increased in 2011, when the new definition was established in Germany, in all BIMD quintiles and dropped slightly in 2012 when the universal two-step GDM screening was introduced (Fig. 1). However, the GDM prevalence remained at a considerably higher level compared to before 2011 in women from deprived areas, but not in women from regions with low level deprivation. Women from the most deprived areas were less likely to be diagnosed with GDM in 2008 (OR [95 % CI] = 0.76 [0.66, 0.86] for the fifth quintile compared to the first quintile in adjusted analyses, Table 2). In contrast, a higher area level deprivation was significantly associated with increased risk of GDM diagnosis in 2013 (OR [95 % CI] = 1.15 [1.02, 1.29] for the fifth quintile compared to the first quintile). The OR was also elevated, although not significantly, in 2014 (OR [95 % CI] = 1.05 [0.93, 1.18]). Further analyses suggested that these trends over time were at least partly based on changes in areas with low employment rates, as employment deprivation was the only BIMD subdomain associated with both lower GDM risk by trend in 2008 (OR [95 % CI] = 0.98 [0.94, 1.02]) and significantly higher risk in 2014 (OR [95 % CI] = 1.05 [1.02, 1.09], Table 3).Fig. 1


Does charge-free screening improve detection of gestational diabetes in women from deprived areas: a cross-sectional study
Yearly rates of gestational diabetes mellitus (GDM) diagnoses from 2008 to 2014 (numbers of pregnancies without pre-gestational diabetes in brackets) in Bavaria, Germany, by deprivation quintiles (Q1-Q5, plot a), and yearly odds ratios with corresponding 95 % confidence intervals for Q5 compared to reference Q1 (plot b, all estimates adjusted for maternal obesity, age, migration background and single mother status). In 2011, the criteria for GDM diagnosis were revised in Germany following WHO recommendations. In 2012, charge-free GDM screening, following a two-step procedure, was established in Germany
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5016952&req=5

Fig1: Yearly rates of gestational diabetes mellitus (GDM) diagnoses from 2008 to 2014 (numbers of pregnancies without pre-gestational diabetes in brackets) in Bavaria, Germany, by deprivation quintiles (Q1-Q5, plot a), and yearly odds ratios with corresponding 95 % confidence intervals for Q5 compared to reference Q1 (plot b, all estimates adjusted for maternal obesity, age, migration background and single mother status). In 2011, the criteria for GDM diagnosis were revised in Germany following WHO recommendations. In 2012, charge-free GDM screening, following a two-step procedure, was established in Germany
Mentions: The rate of GDM diagnosis increased in 2011, when the new definition was established in Germany, in all BIMD quintiles and dropped slightly in 2012 when the universal two-step GDM screening was introduced (Fig. 1). However, the GDM prevalence remained at a considerably higher level compared to before 2011 in women from deprived areas, but not in women from regions with low level deprivation. Women from the most deprived areas were less likely to be diagnosed with GDM in 2008 (OR [95 % CI] = 0.76 [0.66, 0.86] for the fifth quintile compared to the first quintile in adjusted analyses, Table 2). In contrast, a higher area level deprivation was significantly associated with increased risk of GDM diagnosis in 2013 (OR [95 % CI] = 1.15 [1.02, 1.29] for the fifth quintile compared to the first quintile). The OR was also elevated, although not significantly, in 2014 (OR [95 % CI] = 1.05 [0.93, 1.18]). Further analyses suggested that these trends over time were at least partly based on changes in areas with low employment rates, as employment deprivation was the only BIMD subdomain associated with both lower GDM risk by trend in 2008 (OR [95 % CI] = 0.98 [0.94, 1.02]) and significantly higher risk in 2014 (OR [95 % CI] = 1.05 [1.02, 1.09], Table 3).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Gestational diabetes mellitus (GDM) occurs in 2–6 % of all pregnancies. We investigated whether area level deprivation is associated with a higher risk for GDM and whether GDM detection rates in deprived regions changed after the introduction of charge-free GDM screening in Germany in 2012.

Methods: We analyzed population-based data from Bavaria, Germany, comprising n = 587,621 deliveries in obstetric units between 2008 and 2014. Area level deprivation was assessed municipality-based using the Bavarian Index of Multiple Deprivation (BIMD), divided into quintiles and assigned to each mother based on her residential address. We estimated annual odds ratios (ORs) for GDM diagnosis by BIMD quintile with adjustment for maternal obesity, maternal age, migration background and single mother status.

Results: Women from the most deprived regions were less likely to be diagnosed with GDM before introduction of charge-free GDM screening (OR = 0.76 [95 % confidence interval: 0.66, 0.86] compared to least deprived areas), in 2008. In contrast, high area level deprivation was associated with significantly increased risk of GDM diagnosis in 2013 (OR [95 % confidence interval] = 1.15 [1.02, 1.29]). The OR was also elevated, although not significantly, in 2014 (OR [95 % confidence interval] = 1.05 [0.93, 1.18]).

Conclusions: The prevalence of GDM seems to have been underreported in women from highly deprived areas before introduction of the charge-free GDM screening in Germany. In fact, women living in deprived regions seem to have an increased risk for GDM and may profit from access to charge-free GDM screening.

No MeSH data available.


Related in: MedlinePlus