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

Abstract

BackgroundGestational 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.MethodsWe 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.ResultsWomen 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]).ConclusionsThe 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.

Associations of area-level deprivation with adverse obstetric and perinatal outcomes in Bavaria, Germany: Results from a cross-sectional study

“…Therefore, the numbers of pregnant women were not of equal size within each BIMD quintile. However, the same issue occurred also in other studies [6,32], and we do not consider this to be a potential source of bias. Missing covariate data were not evenly distributed across BIMD quintiles and pregnancy outcomes.…”

“…As in a previous publication based on the BAQ data [ 6 ], we assigned the BIMD to the residential postal code of each mother. Based on data from official statistics, the BIMD includes seven domains of deprivation (income (weight on total BIMD: 25%), employment (25%), education (15%), municipal/district revenue (15%), social capital (10%), environment (5%), security (5%)) [ 17 ] for all 96 Bavarian districts (‘Kreise’, 71 rural and 25 urban districts with a minimum of 40.7 thousand, a maximum of 1.46 million and a median size of 115.6 thousand inhabitants as per 31 December 2016; https://www.regionalstatistik.de/genesis/online/ ).…”

“…A large body of the literature has shown that individual socioeconomic status (SES) is associated with various health outcomes [1], and there is evidence that low maternal SES is a potential risk factor for adverse perinatal outcomes [2][3][4]. However, a number of studies indicated that also area-level deprivation is associated with adverse obstetric and perinatal outcomes [5], e. g. gestational diabetes, Caesarian section (CS), preterm delivery, stillbirths or small for gestational age births [6][7][8][9][10][11]. All these outcomes contain major risks for mother and child.…”

No further improvement in pregnancy‐related outcomes in the offspring of mothers with pre‐gestational diabetes in Bavaria, Germany, between 2001 and 2016

“…One limitation is that we were not able to differentiate between Type 1 diabetes and Type 2 diabetes in pregnant women with pre‐gestational diabetes. With respect to gestational diabetes, it should also be noted that adoption of the new WHO diagnostic criteria in Germany in 2011, and the offer of charge‐free gestational diabetes screening in 2012, may have contributed to the observed increase in diagnoses of gestational diabetes . Therefore, the apparent improvement in adverse perinatal outcomes in pregnant women with gestational diabetes may partly be due to a broader inclusion of less severe cases of gestational diabetes, which may have attenuated the associated outcomes .…”

Bridging Gaps and Understanding Disparities in Gestational Diabetes Mellitus to Improve Perinatal Outcomes

“…A cross-sectional study from Germany found a markedly increased uptake in GDM screening when it was provided free of charge. This change resulted in higher rates of GDM diagnosis among low-income women (32). No reliable cost analysis comparing the two screening methods exists.…”