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Acta Diabetologica

, Volume 55, Issue 3, pp 243–251 | Cite as

Maternal educational level and the risk of persistent post-partum glucose metabolism disorders in women with gestational diabetes mellitus

  • Inês Gante
  • Ana Carina Ferreira
  • Gonçalo Pestana
  • Daniela Pires
  • Njila Amaral
  • Jorge Dores
  • Maria do Céu Almeida
  • José Luis Sandoval
Original Article

Abstract

Aims

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Diabetes Gestational Education Women Post-partum 

Notes

Acknowledgements

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).

Funding

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.

Ethical approval

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.

Informed consent

For this type of study using retrospective and anonymised data, participants’ written consent was not required.

Supplementary material

592_2017_1090_MOESM1_ESM.xlsx (332 kb)
Supplementary material 1 (XLSX 331 kb)
592_2017_1090_MOESM2_ESM.docx (29 kb)
Supplementary material 2 (DOCX 29 kb)
592_2017_1090_MOESM3_ESM.pdf (15 kb)
Supplementary material 3 (PDF 15 kb)
592_2017_1090_MOESM4_ESM.pdf (12 kb)
Supplementary material 4 (PDF 11 kb)

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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of ObstetricsMaternidade Bissaya Barreto - Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
  2. 2.Department of NephrologyHospital Curry Cabral - Centro Hospitalar Lisboa CentralLisbonPortugal
  3. 3.Department of CardiologyCentro Hospitalar de São JoãoPortoPortugal
  4. 4.Department of Infectious DiseasesCentro Hospitalar de Lisboa Norte and Faculdade de Medicina de LisboaLisbonPortugal
  5. 5.Infection Control ProgramGeneva University HospitalsGenevaSwitzerland
  6. 6.Department of Obstetrics and GynecologyHospital Beatriz AngeloLouresPortugal
  7. 7.Department of EndocrinologyCentro Hospitalar do PortoPortoPortugal
  8. 8.Unit of Population Epidemiology, Department of Community Medicine, Primary Care, and Emergency MedicineGeneva University HospitalsGenevaSwitzerland

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