Outcomes of gestational diabetes in Sweden depending on country of birth.

ABSTRACT

OBJECTIVE: To analyze maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden, depending on country of birth (Nordic vs. non-Nordic women). DESIGN: Population-based cohort study using the Swedish Medical Birth register. SETTING: Data on pregnant women in Sweden with diagnosed GDM. POPULATION All singleton births to women with GDM between 1998 and 2007 (n = 8560). METHODS: Logistic regression in an adjusted model to assess the risk of adverse maternal and neonatal outcomes. Chi-squared tests or Student's unpaired t-tests were used to analyze differences between maternal and fetal characteristics. MAIN OUTCOME MEASURES: Maternal and neonatal complications. RESULTS: GDM incidence was higher at 2.0% among non-Nordic women, compared with 0.7% in the Nordic group. The non-Nordic women were older, had less chronic hypertensive disease, smoked less, and had lower BMI and shorter height. Preeclampsia was significantly lower in the non-Nordic group. The mean birthweight (3561 vs. 3698 g, p < 0.001) and the large-for-gestational age rate (11.7 vs. 17.5%, p < 0.001) were significantly lower in the non-Nordic group. Large-for-gestational age was dependent on maternal height [crude odds ratio 0.6 (0.5-0.7) and adjusted odds ratio 0.8 (0.6-0.9)]. CONCLUSIONS: Non-Nordic women with GDM in Sweden have better obstetrical and neonatal outcomes than Nordic women. These results do not support the idea of inequality of health care. Large-for-gestational age as a diagnosis is highly dependent on maternal height, which raises the question of the need for individualized growth curves.