Differences in obstetrical and neonatal outcomes for women with gdm in different subgroups of immigrants in Sweden

Introduction

Studies have showed that migrant women have worse perinatal outcomes than women in receiving countries and clinical experience often supports these results. Overall non-nordic immigrants have higher perinatal mortality and stillbirth rate compared to those with Nordic origin.
Questions about equal care have been raised in Sweden. GDM is more common in the non-nordic population which is a challenge regarding information and treatment. Therefore it has been of interest to see if there are differences in outcomes for women with GDM depending on country of birth.

Method

Population based cohort study using the Swedish Medical Birth Register (MBR) from 1998-2007. In the analysed population of 8560 singleton births diagnosed with GDM (0.9%), 5515 women (64.4%) were categorized as Nordic (born in Sweden, Finland, Norway, Denmark or Iceland) and 35.6% hade Non Nordic origin (n= 3046).

The population was divided in 6 subgroups according to size of group:
1: Nordic (Sweden, Finland, Denmark, Iceland, Norway)
2: Iraque, Iran, Libanon (n= 980)
3: China, Vietnam, Thailand, India, South-Korea (n=373),
4: Somalia, Ethiopia (n=303),
5: Yugoslavia, Bosnia-Herzegovina (281),
6: Other countries (1109).

Results

In the Nordic group 96.8% were from Sweden. The non-Nordic
women were older, had less chronic hypertensive disease, smoked less, and had lower BMI and shorter height.
Preeclampsia was significantly lower in the non-Nordic group.
The proportion of insulin treated GDM in the Non Nordic group was (31.2%) vs Nordic group (29.0%); the difference just reached
significance with an OR of 1.1 (1.01-1.2).
In neonatal outcomes there were no significant differences between Nordic and non Nordic women except for lower birth weight and less LGA in the group of Non Nordic women, outcomes dependent on mother´s height (adjusted OR 0.8 (0.6-0.9).

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Conclusions

There are differences in outcomes between immigrant groups, but compared with Nordic women the maternal and neonatal outcomes are better as a whole for non Nordic women.
These results do not support the idea of inequality of health care.
LGA as a diagnosis is highly dependent on maternal height, which points out the need  for individual growth curves.