IS NEIGHBOURHOOD DEPRIVATION A RISK FACTOR FOR GESTATIONAL DIABETES MELLITUS

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IS NEIGHBOURHOOD DEPRIVATION A RISK FACTOR FOR
GESTATIONAL DIABETES MELLITUS?

• Stenhouse E 1 Janghorbani M2 Jones R2 Millward
  A1
• 1Molecular Medicine Research Group, Peninsula
  Medical School, Universities of Exeter and
  Plymouth Plymouth Devon.
• 2 Faculty of Health and Social Work, University
  of Plymouth, Plymouth, Devon.

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Background

• Gestational diabetes mellitus (GDM) is defined as
  carbohydrate intolerance that begins or first
  recognized during pregnancy
• GDM is associated with increased maternal and
  infant morbidity and mortality
• Women with GDM have a 17 - 63 risk of Type 2
  Diabetes Mellitus (T2DM) within 5 -16 years
• Risk factors for GDM are high maternal age,
  weight and parity, previous delivery of
  macrosomic infants, family history of diabetes,
  and race/ethnicity

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Background (2)

• Association between socioeconomic status (SES)
  and T2DM is well established
• Yet evidence on the relationship between GDM and
  SES is limited
• An Italian suggested that the prevalence of GDM
  is increased with decreasing educational level, a
  marker of SES
• Another marker of SES is neighbourhood
  deprivation (ND) a known risk factor for T2DM yet
  little research has been undertaken to explore ND
  and GDM

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Aim

• To explore the relationship between neighbourhood
  deprivation and the prevalence of GDM using
  routinely collected data

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Methods

• 3933 Caucasian pregnant screened for GDM between
  01/01/1996 and 31/12/1997 in Plymouth, South-West
  England
• All mothers undergo routine screening via a
  random plasma glucose at 26 28 weeks gestation
• If this is gt 6.5mmol/l - diagnostic 75g Oral
  glucose tolerance test
• A selection of mothers are identified via risk
  factors

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Methods(2)

• GDM is diagnosed
• 2 hr plasma glucose level 7.8 and/or the
  fasting plasma glucose 6.0 mmol/l
• Data were obtained from
• Plymouth Child Health Database
• Derriford Combined Laboratory database
• Midwifery care notes
• Data included
• date of birth of mother and infant
• babys gender
• gestational age (weeks)
• birth weight
• post code

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Methods (2)

• Level of ND was calculated by the use of Townsend
  Material Deprivation Score (TMDS) and small area
  boundaries
• (Small area refers to neighbourhood units in
  Plymouth with an average population of 5,500
  residents)
• TMDS ranged from - 5.0 to 8.1
• (Higher scores indicate high deprivation)
• The TMDS were divided into three equal tertiles

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Analysis

• Comparisons between means
• Students t-test for independent samples
• Comparisons between proportions
• Chi-square or Fishers exact test
• Correlation between continuous variables
• Pearson coefficient
• Analysis of factors relating to GDM
• Stepwise logistic regression

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Results

• 65 (1.7) 95 CI 1.20, 2.11 women with
• and
• 3868 (98.3) without GDM
• Women with GDM were
• older
• higher mean random plasma glucose level
• Higher infant birth weight
• Lower mean TMDS

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Results (2)

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Results (3)

• However when further analysis was performed to
  determine the independent predictors of factors
  associated with GDM (mothers age, TMDS and
  birth weight
• Mothers from the most deprived neighbourhoods
  were less likely to develop GDM than those from
  the most affluent areas
• TMDS, birth weight and gender had no significant
  independent association with GDM  
• Relative Prevalence 0.50 (95 CI 0.27, 0.94) p
  0.06
• The mean age at delivery decreased with
  increasing TMDS in both mothers with r -0.325
  p lt 0.01 and without GDM r -0.246 p lt 0.001  

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Discussion

• Studies would suggest that women from more
  deprived areas might be at higher risk of GDM
  compared to those in more affluent areas
• Our study found no such relationship
• Adjusting for other risk factors
• older women were more likely to develop GDM
• Yet deprivation and birth weight had no impact on
  the risk of GDM

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Conclusions

• The findings of this study support the notion
  that the neighbourhood context in which women
  live has no impact on the risk of GDM.
• To our knowledge, this is the first
  representative study to assess association
  between neighbourhood context and GDM
• It highlights the need for further studies that
  identify sub-populations at high risk for GDM
• In particular work in areas where there is no
  marked association between deprivation and age
  would be worthwhile