Diabetic Medicine
Volume 34, Issue 11, 2017, Pages 1608-1614

Gestational diabetes care and outcomes for refugee women: a population-based cohort study (Article)

Khan S. , Yao Z. , Shah B.R.*
  • a Department of Medicine, University of Toronto, Canada
  • b Institute for Clinical Evaluative Sciences, Canada
  • c Department of Medicine, University of Toronto, Canada, Institute for Clinical Evaluative Sciences, Canada, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Abstract

Aim: To determine the prevalence of adverse clinical outcomes, the rates of healthcare utilization, and the incidence of post-partum Type 2 diabetes in refugees with gestational diabetes (GDM), compared with other immigrants and non-immigrants. Methods: A population-based cohort study was conducted using healthcare databases in Ontario, Canada. Over 40 000 women with GDM having singleton live births between 2002 and 2014 were identified. We identified GDM adverse outcomes such as macrosomia, pre-eclampsia and respiratory distress syndrome. Antenatal and newborn healthcare utilization were ascertained. Women were then followed for diagnosis of diabetes post-partum. Results: Both refugees and other immigrants had a lower rate than non-immigrants of many adverse GDM outcomes, including pre-eclampsia [relative risk (RR) 0.65, 95% confidence interval (95% CI) 0.44–0.95 and 0.61, 95% CI 0.52–0.72, respectively], preterm birth (RR 0.87, 95% CI 0.75–0.995 and 0.85, 95% CI 0.80–0.91, respectively), and respiratory distress syndrome (RR 0.83, 95% CI 0.70–0.97 and 0.78, 95% CI 0.72–0.84, respectively). However, refugees were less likely to attend well-baby care in time for the first routine vaccination (RR 0.92, 95% CI 0.88–0.95). Incidence of post-partum diabetes was high in all groups, but refugee women were at increased risk (hazard ratio 1.23, 95% CI 1.11–1.37). Conclusions: Despite different circumstances leading to migration, refugees have a similar ‘healthy immigrant effect’ to other immigrants, with respect to adverse GDM outcomes. However, newborns of refugees were less likely to have well-baby care, and refugee women were also at especially high risk of developing diabetes post-partum. These are both important public health issues. © 2017 Diabetes UK

Author Keywords

[No Keywords available]

Index Keywords

clinical outcome immigrant newborn care refugee prenatal care population based case control study non insulin dependent diabetes mellitus pregnancy complication Pregnancy Complications follow up Diabetes Mellitus, Type 2 human Refugees Cohort Studies statistics and numerical data controlled study premature labor social status Humans Treatment Outcome Infant, Newborn maternal hypertension female adverse outcome risk factor newborn pregnancy hypoglycemia prevalence Incidence Article obstetric delivery health care utilization low birth weight pregnancy outcome Ontario adult major clinical study respiratory distress syndrome preeclampsia live birth cohort analysis parity ethnicity puerperal disorder Puerperal Disorders Pre-Eclampsia Fetal Macrosomia vaccination macrosomia case control study Postpartum Period puerperium cesarean section Diabetes, Gestational pregnancy diabetes mellitus

Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85031498650&doi=10.1111%2fdme.13440&partnerID=40&md5=894b3e6853d819faf1b95e0f6b63650e

DOI: 10.1111/dme.13440
ISSN: 07423071
Cited by: 5
Original Language: English