Impact of maternal income on the risk of gestational diabetes mellitus in primiparous women

Abstract

Aims Findings concerning the impact of socio‐economic status on the risk of gestational diabetes mellitus (GDM) are inconclusive and little is known about the simultaneous impact of income and educational attainment on the risk of GDM. This study aims to assess the impact of maternal prepregnancy income in combination with traditional GDM risk factors on the incidence of GDM in primiparous women. Methods This is an observational cohort study including 5962 Finnish women aged ≥ 20 years from the city of Vantaa, Finland, who delivered for the first time between 2009 and 2015, excluding women with pre‐existing diabetes mellitus. The Finnish Medical Birth Register, Finnish Tax Administration, Statistics Finland, Social Insurance Institution of Finland and patient healthcare records provided data for the study. We divided the study population according to five maternal income levels and four educational attainment levels. Results Incidence of GDM decreased with increasing income level in primiparous women (P < 0.001 for linearity, adjusted for smoking, age, BMI and cohabiting status). In an adjusted two‐way model, the relationship was significant for both income (P = 0.007) and education (P = 0.039), but there was no interaction between income and education (P = 0.52). Conclusions There was an inverse relationship between both maternal prepregnancy taxable income and educational attainment, and the risk of GDM in primiparous Finnish women.

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

“…In our study cohort, there was a trend of education having a protective effect on GDM. The finding was, however, significant only when comparing women with GDM only in the second pregnancy (GDM−/+) with women without Table 2 Relative risk ratio (RRR) a of patient characteristics at the first pregnancy to predict risk of gestational diabetes (GDM) only in the first pregnancy, only in the second pregnancy, and in both pregnancies In our prior study, including a larger cohort of primiparous women, incidence of GDM showed an inverse association with educational attainment [22]. Further, there was no association between educational attainment and recurrence of GDM in the current study.…”

“…The finding was, however, significant only when comparing women with GDM only in the second pregnancy (GDM−/+) with women without GDM in neither pregnancy (GDM−/−). In our prior study, including a larger cohort of primiparous women, incidence of GDM showed an inverse association with educational attainment [ 22 ]. Further, there was no association between educational attainment and recurrence of GDM in the current study.…”

“…Further, there was no association between educational attainment and recurrence of GDM in the current study. Although some prior studies, including both primiparous and multiparous women, have found low-educated women having a higher risk of GDM than high-educated women [ 18 , 19 , 22 ]. However, in some other studies, no such association between education and risk of GDM has been detected [ 20 , 21 ].…”

“…In 2016, we initiated a follow-up cohort study to assess the long-term consequences of gestational glucose intolerance on the health of women and their offspring in the city of Vantaa, Finland. We have previously shown that within this cohort, income and education are inversely associated with the occurrence of GDM in primiparous women [ 22 ]. This paper, assessing a subgroup from the prior study, aims to evaluate further the influence of maternal educational attainment on the presence of GDM in the first two pregnancies leading to delivery, also taking into account traditional risk factors like maternal age and adiposity for GDM.…”

Gestational Diabetes Mellitus: A Harbinger of the Vicious Cycle of Diabetes

“…Based on observational studies, many women diagnosed with GDM are unaware of the risk factors and complications of their diagnosis [ 107 , 108 , 109 ]. A study in Finland reported that there was an inverse relationship between socioeconomic status and GDM [ 110 ]. This is supported by findings that patients who are uninsured and underinsured receive less preventive healthcare, with some receiving little or no healthcare at all [ 111 , 112 ].…”