Does charge-free screening improve detection of gestational diabetes in women from deprived areas: a cross-sectional study.
Gestational diabetes mellitus (GDM) occurs in 2-6 % of all pregnancies. We investigated whether area level deprivation is associated with a higher risk for GDM and whether GDM detection rates in deprived regions changed after the introduction of charge-free GDM screening in Germany in 2012.



We analyzed population-based data from Bavaria, Germany, comprising n = 587,621 deliveries in obstetric units between 2008 and 2014. Area level deprivation was assessed municipality-based using the Bavarian Index of Multiple Deprivation (BIMD), divided into quintiles and assigned to each mother based on her residential address. We estimated annual odds ratios (ORs) for GDM diagnosis by BIMD quintile with adjustment for maternal obesity, maternal age, migration background and single mother status.



Women from the most deprived regions were less likely to be diagnosed with GDM before introduction of charge-free GDM screening (OR = 0.76 [95 % confidence interval: 0.66, 0.86] compared to least deprived areas), in 2008. In contrast, high area level deprivation was associated with significantly increased risk of GDM diagnosis in 2013 (OR [95 % confidence interval] = 1.15 [1.02, 1.29]). The OR was also elevated, although not significantly, in 2014 (OR [95 % confidence interval] = 1.05 [0.93, 1.18]).



The prevalence of GDM seems to have been underreported in women from highly deprived areas before introduction of the charge-free GDM screening in Germany. In fact, women living in deprived regions seem to have an increased risk for GDM and may profit from access to charge-free GDM screening.
Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany. andreas.beyerlein@helmholtz-muenchen.de.|Forschergruppe Diabetes der Technischen Universität München, Munich, Germany. andreas.beyerlein@helmholtz-muenchen.de.
Andreas
A
Beyerlein
Department of Health Services Management, Munich School of Management, Ludwig-Maximilians-Universität München, Munich, Germany.
Daniela
D
Koller
Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany.|Forschergruppe Diabetes der Technischen Universität München, Munich, Germany.|Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Munich, Germany.|German Center for Diabetes Research (DZD), Partner, Neuherberg, Germany.
Anette-Gabriele
AG
Ziegler
German Bavarian Quality Assurance Institute for Medical Care, Munich, Germany.
Nicholas
N
Lack
German Center for Diabetes Research (DZD), Partner, Neuherberg, Germany.|Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
Werner
W
Maier
D000328:Adult; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics* / Q000379:methods; D015995:Prevalence; D012307:Risk Factors
Area level deprivation; Bavarian index of multiple deprivation; Charge-free screening; Gestational diabetes mellitus