Maternal educational level and the risk of persistent post-partum glucose metabolism disorders in women with gestational diabetes mellitus
Gestational diabetes mellitus (GDM) occurs in 5–15% of pregnancies, and lower maternal educational attainment has been associated with higher risk of GDM. We aimed to determine if maternal education level is associated with persistent post-partum glucose metabolism disorders in women with GDM.
Retrospective cohort study of women with GDM followed in 25 Portuguese health institutions between 2008 and 2012. Educational attainment was categorised into four levels. Prevalence of post-partum glucose metabolism disorders (type 2 diabetes mellitus, increased fasting plasma glucose or impaired glucose tolerance) was compared and adjusted odds ratios calculated controlling for confounders using logistic regression.
We included 4490 women diagnosed with GDM. Educational level ranged as follows: 6.8% (n = 307) were at level 1 (≤ 6th grade), 34.6% (n = 1554) at level 2 (6–9th grade), 30.4% (n = 1364) at level 3 (10–12th grade) and 28.2% (n = 1265) at level 4 (≥ university degree). At 6 weeks post-partum re-evaluation, 10.9% (n = 491) had persistent glucose metabolism disorders. Educational levels 1 and 2 had a higher probability of persistent post-partum glucose metabolism disorders when compared to level 4 (OR = 2.37 [1.69;3.32], p < 0.001 and OR = 1.39 [1.09;1.76], p = 0.008, for level 1 and 2, respectively), an association that persisted in multivariable logistic regression adjusting for confounders (level 1 OR = 2.25 [1.53;3.33], p < 0.001; level 2 OR = 1.43 [1.09;1.89], p = 0.01).
Persistent post-partum glucose metabolism disorders are frequent in women with GDM and associated with lower maternal educational level. Interventions aimed at this risk group may contribute towards a decrease in prevalence of post-partum glucose metabolism disorders.
KeywordsDiabetes Gestational Education Women Post-partum
We thank the multidisciplinary teams of obstetricians and diabetologists of Portuguese health institutions who collected patient data for the National Registry of Gestational Diabetes. In addition, we would like to acknowledge the alumni and faculty of the Harvard Medical School—Portugal Clinical Scholars Research Training Programme for useful scientific discussions. DP was partially supported by Fundação para a Ciência e Tecnologia under the Program for doctoral training in clinical research for medical interns (SFRH/SINT/95317/2013).
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
For this type of study using retrospective and anonymised data, participants’ written consent was not required.
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