Psychosocial deprivation in women with gestational diabetes mellitus is associated with poor fetomaternal prognoses: an observational study.
OBJECTIVE
To evaluate the prognoses associated with psychosocial deprivation in women with gestational diabetes mellitus (GDM).


METHODS
Observational study considering the 1498 multiethnic women with GDM who gave birth between January 2009 and February 2012.


METHODS
Four largest maternity units in the northeastern suburban area of Paris.


METHODS
The 994 women who completed the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire.


METHODS
Main complications of GDM (large infant for gestational age (LGA), shoulder dystocia, caesarean section, pre-eclampsia).


RESULTS
Psychosocial deprivation (EPICES score ≥30.17) affected 577 women (56%) and was positively associated with overweight/obesity, parity and non-European origin, and negatively associated with family history of diabetes, fruit and vegetable consumption and working status. The psychosocially deprived women were diagnosed with GDM earlier, received insulin treatment during pregnancy more often and were more likely to have LGA infants (15.1% vs 10.6%, OR=1.5 (95% CI 1.02 to 2.2), p<0.05) and shoulder dystocia (3.1% vs 1.2%, OR=2.7 (0.97 to 7.2), p<0.05). In addition to psychosocial deprivation, LGA was associated with greater parity, obesity, history of GDM, ethnicity, excessive gestational weight gain and insulin therapy. A multivariate analysis using these covariates revealed that the EPICES score was independently associated with LGA infants (per 10 units, OR=1.12 (1.03 to 1.20), p<0.01).


CONCLUSIONS
In our area, psychosocial deprivation is common in women with GDM and is associated with earlier GDM diagnoses and greater insulin treatment, an increased likelihood of shoulder dystocia and, independently of obesity, gestational weight gain and other confounders with LGA infants.
Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France.
Emmanuel
E
Cosson
Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France Department of Diabetology, Metabolic Diseases, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, Bobigny, France.
Hélène
H
Bihan
Department of Diabetology, Metabolic Diseases, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, Bobigny, France.
Gérard
G
Reach
Department of Endocrinology-Diabetology, Ballanger Hospital, Aulnay-Sous-Bois, France.
Laurence
L
Vittaz
Department of Obstetrics and Gynecology, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Bondy, France.
Lionel
L
Carbillon
Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France.
Paul
P
Valensi
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004420:Dystocia / Q000453:epidemiology*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D009765:Obesity / Q000453:epidemiology; D010297:Paris / Q000453:epidemiology; D010298:Parity; D011203:Poverty / Q000706:statistics & numerical data*; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D011379:Prognosis; D012923:Social Class; D011795:Surveys and Questionnaires; D015430:Weight Gain
D007328:Insulin
OBSTETRICS; SOCIAL MEDICINE