ESPE Yearbook of Paediatric Endocrinology

J Clin Endocrinol Metab. 2021 Nov 19;106(12):e5075-e5087. doi: 10.1210/clinem/dgab528. PMID: 34272865.

Brief Summary: This national birth registry study in Denmark collected data on gestational diabetes and adverse pregnancy outcomes in relation to country of origin of the mother. Country of origin and the number of births were associated with adverse effects from gestational diabetes.

There is a global variation in the prevalence of gestational diabetes mellitus (GDM) with the risk being particularly high in Asian women (1). Maternal country of origin may affect the outcomes of GDM such as pre-eclampsia, planned caesarean section, emergency caesarean section, preterm delivery, large for gestational age (LGA) and small for gestational age (SGA). For example, among women giving birth in Denmark, women born in Pakistan, India, Morocco, and Sri Lanka have 3- to 5-fold higher odds of GDM compared with native Danish-born women (2).

So, to address the question if the maternal country of origin has any adverse effects on GDM outcome, the authors used the Denmark nationwide singleton birth database to collect information on maternal origin, GDM and pregnancy outcomes. They found that GDM increased the odds risk of adverse pregnancy outcomes. More specifically, country of origin modified the effect of GDM on pre-eclampsia, LGA, and SGA in singleton deliveries. However, there was no effect of GDM on planned cesarean section, emergency cesarean section, and preterm delivery. Different immigrant groups had higher odds of different GDM-associated adverse pregnancy outcomes, and there were differences in GDM-associated adverse pregnancy outcomes between countries of origin often grouped together.

For example, GDM increased the risk of pre-eclampsia among women from Denmark, Lebanon and Morocco, and GDM was associated with increased risk of LGA among women from most countries, particularly women from Sri Lanka. The odds of having a neonate with SGA was increased in women with GDM who came from India, Lebanon, Pakistan, Iraq, and Somalia. Thus, this study highlights the importance of increased awareness to both immigrant background and GDM status in the clinical assessment of pregnant women.

References: 1. International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels, Belgium; 2019. 2. Kragelund Nielsen K, Andersen GS, Damm P, Andersen AN. Gestational Diabetes Risk in Migrants. A Nationwide, Register-Based Study of all Births in Denmark 2004 to 2015. J Clin Endocrinol Metab. 2020;105(3):e692–e703.