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Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study

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Abstract

Aims

To investigate whether maternal educational level is associated with gestational diabetes mellitus (GDM), and to what extent risk factors for GDM mediate the effect of educational level.

Methods

We examined data of 7,511 pregnant women participating in a population-based cohort study in Rotterdam, the Netherlands. The highest achieved education was categorized into four levels. Diagnosis of GDM was retrieved from delivery records. Odds ratios (OR) of GDM were calculated for levels of education, adjusting for confounders and potential mediators. Mediators were selected according to Baron and Kenny’s causal step approach.

Results

Adjusted for ethnicity, age, family history of diabetes and parity, women in the lowest educational level were three times more likely to develop GDM than women in the highest level (OR 3.07; 95 % CI 1.37, 6.89). Selected mediators were alcohol use and body mass index (BMI). Additional adjustment for alcohol use attenuated the OR to 2.54 (95 % CI 1.11, 5.78). The individual addition of BMI attenuated the OR to 2.35 (95 % CI 1.03, 5.35). All mediators together explained 51 % (95 % CI −122, −25) of the association between low education and GDM.

Conclusions

Low maternal educational level is associated with GDM, which is mainly due to higher rates of overweight and obesity. In order to reduce the higher rates of GDM, and consequently type 2 diabetes among women in low socioeconomic subgroups, prevention and intervention strategies need to be focused on reducing the rates of overweight and obesity before pregnancy.

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Acknowledgments

The Generation R Study is conducted by the Erasmus Medical Centre in close collaboration with the Erasmus University Rotterdam, School of Law and Faculty of Social Sciences, the Municipal Health Service Rotterdam area, Rotterdam, the Rotterdam Homecare Foundation, Rotterdam and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR), Rotterdam. We gratefully acknowledge the contribution of general practitioners, hospitals, midwives and pharmacies in Rotterdam.

Conflict of interest

Selma H. Bouthoorn, Lindsay M. Silva, Sheila E. Murray, Eric A. P. Steegers, Vincent W. V. Jaddoe, Henriette Moll, Albert Hofman, Johan P. Mackenbach and Hein Raat declare that they have no conflict of interest.

Human and animal rights disclosure

The study was conducted in accordance with the guidelines proposed in the World Medical Association Declaration of Helsinki and has been approved by the Medical Ethical Committee of the Erasmus MC, University Medical Centre Rotterdam [16].

Informed consent disclosure

Written consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. The Generation R Study Group, Erasmus Medical Center, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Selma H. Bouthoorn, Vincent W. V. Jaddoe & Albert Hofman

  2. Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands

    Selma H. Bouthoorn, Sheila E. Murray, Johan P. Mackenbach & Hein Raat

  3. Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands

    Lindsay M. Silva, Vincent W. V. Jaddoe & Henriette Moll

  4. Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands

    Eric A. P. Steegers

  5. Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands

    Vincent W. V. Jaddoe & Albert Hofman

Authors
  1. Selma H. Bouthoorn
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  2. Lindsay M. Silva
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  3. Sheila E. Murray
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  5. Vincent W. V. Jaddoe
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  6. Henriette Moll
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  7. Albert Hofman
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  8. Johan P. Mackenbach
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  9. Hein Raat
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Corresponding author

Correspondence to Selma H. Bouthoorn.

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Bouthoorn, S.H., Silva, L.M., Murray, S.E. et al. Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. Acta Diabetol 52, 445–452 (2015). https://doi.org/10.1007/s00592-014-0668-x

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  • DOI: https://doi.org/10.1007/s00592-014-0668-x

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