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Eskildsen FR, Davidsen E, Sørensen JB, Kragelund Nielsen K. Maternal responsibility and omission of complexity: an exploration of the portrayal of gestational diabetes mellitus in Danish written media. BMJ Open 2024; 14:e079772. [PMID: 38296270 PMCID: PMC10828855 DOI: 10.1136/bmjopen-2023-079772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) has implications for the future health of both mother and offspring, and there is a risk that mothers are held responsible and blamed for their own and their offspring's long-term health. The media plays a significant role in shaping public perceptions of health. Therefore, our study aimed to investigate how GDM and women with GDM are portrayed in Danish written media. DESIGN We identified written newspaper articles reporting on GDM from 2018 to 2019 and analysed them using thematic network analysis and elements from critical discourse analysis. RESULTS In total, 130 articles were included in the analysis. Four themes emerged: (1) ways of introducing GDM, (2) descriptions of causes and prevention of GDM, (3) descriptions of consequences of GDM and (4) value-laden descriptions of GDM. GDM was often mentioned in relation to other conditions or factors and with lack of differentiation. Maternal responsibility was emphasised via oversimplified descriptions of causal relations, descriptions of individual agency and no emphasis on structural causes and preventive measures. GDM was positioned as resulting in 'bad pregnancies' using value-laden wordings. CONCLUSION We identified various aspects of how GDM is portrayed in written media. The findings signal the importance of clear, nuanced and respectful communication on GDM, including conveying the complexity of the condition and the role of structural factors.
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Affiliation(s)
- Fiona Ryom Eskildsen
- Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Emma Davidsen
- Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Karoline Kragelund Nielsen
- Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen, Herlev, Denmark
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Kotzaeridi G, Monod C, Linder T, Eppel D, Seidel V, Feichtinger M, Mosimann B, Filippi V, Wegener S, Henrich W, Tura A, Göbl CS. The impact of regional origin on the incidence of gestational diabetes mellitus in a multiethnic European cohort. Front Public Health 2024; 11:1286056. [PMID: 38312137 PMCID: PMC10834617 DOI: 10.3389/fpubh.2023.1286056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/28/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Women with migration background present specific challenges related to risk stratification and care of gestational diabetes mellitus (GDM). Therefore, this study aims to investigate the role of ethnic origin on the risk of developing GDM in a multiethnic European cohort. Methods Pregnant women were included at a median gestational age of 12.9 weeks and assigned to the geographical regions of origin: Caucasian Europe (n = 731), Middle East and North Africa countries (MENA, n = 195), Asia (n = 127) and Sub-Saharan Africa (SSA, n = 48). At the time of recruitment maternal characteristics, glucometabolic parameters and dietary habits were assessed. An oral glucose tolerance test was performed in mid-gestation for GDM diagnosis. Results Mothers with Caucasian ancestry were older and had higher blood pressure and an adverse lipoprotein profile as compared to non-Caucasian mothers, whereas non-Caucasian women (especially those from MENA countries) had a higher BMI and were more insulin resistant. Moreover, we found distinct dietary habits. Non-Caucasian mothers, especially those from MENA and Asian countries, had increased incidence of GDM as compared to the Caucasian population (OR 1.87, 95%CI 1.40 to 2.52, p < 0.001). Early gestational fasting glucose and insulin sensitivity were consistent risk factors across different ethnic populations, however, pregestational BMI was of particular importance in Asian mothers. Discussion Prevalence of GDM was higher among women from MENA and Asian countries, who already showed adverse glucometabolic profiles at early gestation. Fasting glucose and early gestational insulin resistance (as well as higher BMI in women from Asia) were identified as important risk factors in Caucasian and non-Caucasian patients.
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Affiliation(s)
- Grammata Kotzaeridi
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Cécile Monod
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Tina Linder
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Daniel Eppel
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Vera Seidel
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Beatrice Mosimann
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Valeria Filippi
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - Silke Wegener
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Henrich
- Clinic of Obstetrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andrea Tura
- Metabolic Unit, CNR Institute of Neuroscience, Padova, Italy
| | - Christian S. Göbl
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynaecology, Division of Obstetrics, Medical University of Graz, Graz, Austria
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Orós M, Perejón D, Serna MC, Siscart J, Leon J, Ortega M, Salinas-Roca B. Prevalence and risk factors of gestational diabetes in the health region of Lleida: a retrospective observational cohort study. J Endocrinol Invest 2023; 46:2639-2646. [PMID: 37330946 PMCID: PMC10632204 DOI: 10.1007/s40618-023-02120-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/20/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Diabetes is a very common metabolic condition during pregnancy. The number of cases increases with age and obesity. The prevalence of pre-gestational diabetes and gestational diabetes (GD) differs between different ethnic groups. OBJECTIVE The aim of the study was to analyse the prevalence of pre-gestational diabetes and GD in the health region of Lleida. We also studied the GD risk factors during pregnancy according to the country of origin of the pregnant woman. METHODS We performed a retrospective observational cohort study among pregnant women between 2012 and 2018 in the health region of Lleida. A multivariate model was performed with the different variables analysed by calculating the regression coefficient and its 95% confidence interval (CI). RESULTS In our sample of 17,177 pregnant women, we observed a prevalence of pre-gestational diabetes and GD of 8.2% and 6.5%, respectively. We found a relationship of gestational diabetes with different factors: age, with 6.8% in 30-34 year-old women and 11.3% in women over 35 (OR 1.78 and 3.29, respectively); overweight, with 8.29% (OR 1.89); and obesity, with 12.9% (OR 3.15). Finally, women from Asia and the Middle East and the Maghreb had a higher risk of diabetes, with 12.2% (OR 2.1) and 9.91% (OR 1.3), respectively, and Sub-Saharan women had a lower risk of it 6.07% (OR 0.71). CONCLUSIONS GD has different risk factors, such as age, overweight, and obesity. Non-related conditions include hypothyroidism, arterial hypertension, and dyslipidaemia. Finally, pregnant women from the Maghreb, and Asia and the Middle East, are at higher risk of developing diabetes during pregnancy; meanwhile, Sub-Saharan origin is protector factor.
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Affiliation(s)
- M Orós
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Centre de Salut Eixample, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
| | - D Perejón
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Centre de Salut Eixample, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
| | - M C Serna
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Centre de Salut Eixample, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
| | - J Siscart
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Centre de Salut Eixample, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
| | - J Leon
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Grup d'investigació en Immunologia i Metabolisme (GRIM), Institut de Recerca Biomèdica, Lleida, Spain
| | - M Ortega
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut, Lleida, Spain
- Departament de Medicina Familiar, Universitat de Lleida, Lleida, Spain
- Grup de Recerca Terapèutica en Atenció Primària (GRETAPS), Institut Català de la Salut, Lleida, Spain
| | - B Salinas-Roca
- Department of Nursing and Physiotherapy, University of Lleida, Montserrat Roig 2, 25198, Lleida, Spain.
- Global Research On Wellbeing (GRoW) Research Group, Blanquerna School of Health Science, Ramon Llull University, Padilla, 326-332, 08025, Barcelona, Spain.
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Noah AI, Perez-Patron MJ, Gongalla M, Hill AV, Taylor BD. Foreign-born status and risk of gestational diabetes mellitus by years of residence in the United States. Sci Rep 2023; 13:10060. [PMID: 37344555 DOI: 10.1038/s41598-023-36789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
To explore the association between acculturation among foreign-born (FB) women, gestational diabetes (GDM) and GDM-associated adverse birth outcomes, we conducted a retrospective cohort study of 34,696 singleton pregnancies from Houston, TX, between 2011 and 2022. FB women (n = 18,472) were categorized based on years of residence in US (0-5, 6-10, and > 10 years), while US-born women (n = 16,224) were the reference group. A modified Poisson regression model determined the association between acculturative level and GDM within the entire cohort and stratified by race/ethnicity. Compared to US-born women, FB women with 0-5 years [adjusted relative risk (RRadj.) 1.27, 95% confidence interval [CI] 1.14-1.42)], 6-10 years (RRadj. 1.89, 95%CI 1.68-2.11) and > 10 years in the US (RRadj. 1.85, 95%CI 1.69-2.03) had higher risk of GDM. Results were consistent for all racial/ethnic groups, although associations were not significant at 0-5 years. FB women had lower risk of other adverse pregnancy outcomes, except for preeclampsia with severe features at higher levels of acculturation. Results were similar among those with and without GDM. In conclusion, FB status increases risk of GDM among all racial/ethnic groups but is elevated with higher acculturation levels.
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Affiliation(s)
- Akaninyene I Noah
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch, MRB, 11.158A, 301 University Blvd, Galveston, TX, 77555, USA
| | - Maria J Perez-Patron
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Megha Gongalla
- Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, PA, USA
| | - Ashley V Hill
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Brandie DePaoli Taylor
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch, MRB, 11.158A, 301 University Blvd, Galveston, TX, 77555, USA.
- Department of Population Health and Health Disparities, University of Texas Medical Branch, Galveston, TX, USA.
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Stalheim AM, Iversen MM, Jenum AK, Sletner L, Stafne SN, Qvigstad E, Sagedal L, Nilsen RM, Aasheim V, Strandberg RB. Seasonal variation in gestational diabetes mellitus among women in Norway: a national population-based study. BMJ Open 2023; 13:e063725. [PMID: 36918247 PMCID: PMC10016255 DOI: 10.1136/bmjopen-2022-063725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES Previous research on seasonal variation in the incidence of gestational diabetes mellitus (GDM) has shown inconclusive results. Furthermore, little is known about whether a seasonal variation in GDM might be associated with the maternal country of birth. We examined whether there was seasonal variation in GDM incidence by the maternal country background. DESIGN National population-based registry study. SETTING AND PARTICIPANTS We used national population-based data from the Medical Birth Registry of Norway (MBRN), n=1 443 857 (1990-2016) and data from four merged community-based studies (4GDM) with universal screening for GDM, n=2 978 (2002-2013). OUTCOME MEASURES The association between season of pregnancy onset with incidence of GDM was examined separately in both datasets using logistic regression analyses, stratified by the mother's country background using two broad geographical categories (MBRN: Norwegian and immigrant; 4GDM: European and African/Asian ethnicity). Winter season was used as reference category. RESULTS The incidence of GDM in MBRN was highest when the pregnancy started during the winter (Norwegian-born: 1.21%; immigrants: 3.32%) and lowest when pregnancy started during the summer for both Norwegian and immigrant women (Norwegian-born: 1.03% (OR 0.85, 95% CI 0.81 to 0.98); immigrants: 2.99% (OR 0.90, 95% CI 0.84 to 0.96)). The 4GDM data showed that women with European ancestry had the highest incidence of GDM when pregnancy started during autumn (10.7%, OR 1.01, 95% CI 0.69 to 1.46) and winter (10.6%), while ethnic African and Asian women had the highest incidence when pregnancy onset was during the summer (15.3%, OR 1.17, 95% CI 0.54 to 2.53). CONCLUSIONS Based on national population-based data, this study suggests that GDM incidence varies by season in both Norwegian-born and immigrant women. The 4GDM dataset did not show a clear seasonal variation in GDM incidence, possibly due to the relatively small sample. Causes for the seasonal variation in GDM should be explored further.
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Affiliation(s)
- Astrid Melteig Stalheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | | | - Anne Karen Jenum
- Department of General Practice, General Practice Unit (AFE), Insitute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Line Sletner
- Department for Paediatric and Adolescent Medicine, Akershus University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Signe N Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Sagedal
- Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway
| | - Roy Miodini Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Vigdis Aasheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Scheuer CM, Andersen MH, Mathiesen ER, Ringholm L, Müller CL, Truong JM, Lie-Olesen MM, Overgaard M, McIntyre HD, Jensen DM, Damm P, Clausen TD. Regional divergence and time trends in the prevalence of gestational diabetes mellitus: a national Danish cohort study. Acta Diabetol 2023; 60:379-386. [PMID: 36539623 PMCID: PMC9931790 DOI: 10.1007/s00592-022-02013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIMS To evaluate the prevalence and time trends of gestational diabetes mellitus (GDM) across the five regions of Denmark with uniform national guidelines for screening and diagnosing GDM. METHODS This register-based national cohort study included 287,684 births from 2013 to 2017. Trends in GDM prevalence over time and differences between the five regions were evaluated. Crude and adjusted odd ratios (ORs) for GDM were calculated including potential confounding clinical risk factors as age, BMI, educational level, marital status, parity, country of origin and assisted reproduction. RESULTS From 2013 to 2017, GDM prevalence in Denmark increased by 7% per year (OR 1.07, 95% CI 1.06-1.09, P < 0.001). GDM prevalence varied considerably between regions and ranged from 3.0 to 5.9% in 2017, corresponding to a maximal regional difference of 97%. In crude analyses, the risk of GDM in 2017 was significantly different in four of five regions compared to the remaining regions (OR ranging from 0.60 to 1.55), and these differences persisted after adjusting for confounding clinical risk factors (adjusted OR: 0.59-1.45). CONCLUSION The prevalence of GDM increased over time in all Danish regions with substantial regional divergence. Up to a 97%, difference in GDM prevalence was observed between Danish regions, which was not explained by available clinical risk factors. This occurred despite national guidelines and raises the question of whether regional variations in screening efficacy, diagnostic procedures or inequality in clinical health care access may explain the observed differences.
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Affiliation(s)
- Cathrine M Scheuer
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
| | - Maria H Andersen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Elisabeth R Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
| | - Clara L Müller
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Jun-Mei Truong
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - H David McIntyre
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Lin LJJ, Saliba B, Adams J, Peng W. Prevalence and risk factors contributing to the occurrence of diabetes mellitus in Chinese international migrants: A narrative review. Diabetes Res Clin Pract 2023; 197:110560. [PMID: 36738829 DOI: 10.1016/j.diabres.2023.110560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
AIMS This paper reviewed the literature on diabetes prevalence and risk factors associated with diabetes among first-generation Chinese international migrants. METHODS MEDLINE, Scopus, Web of Science, CINAHL and Maternity and Infant Care were searched until March 2022, for articles written in English. The quality of the included articles was assessed using the Newcastle-Ottawa Scale. RESULTS In total, 17 articles were included (nine for gestational diabetes, six for type 2 diabetes, and none for type 1 diabetes). The average crude prevalence rate for type 2 diabetes and gestational diabetes was 12.1% and 9.3% respectively. Risk factors contributing to the occurrence of type 2 diabetes included older age, sex, family history of type 2 diabetes, higher BMI/waist circumference, longer time since migration, alcohol consumption, smoker, hypertension, and high triglycerides. Risk factors contributing to the occurrence of gestational diabetes included older maternal age, history of gestational diabetes, higher weight/pre-pregnancy BMI, longer time since migration, and Chinese ethnicity. CONCLUSIONS We identified a research gap in the diabetes health of Chinese migrants, particularly for type 1 diabetes, highlighting the need for ethnic-specific diabetes research and care, including for subsequent generations of migrants and those living in developing countries.
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Affiliation(s)
- Li Jia Jennifer Lin
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Bernard Saliba
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Wenbo Peng
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
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Nilsen RM, Klungsøyr K, Stigum H. Adjusting for outcome risk factors in immigrant datasets: total or direct effects? BMC Med Res Methodol 2023; 23:37. [PMID: 36765287 PMCID: PMC9912500 DOI: 10.1186/s12874-023-01861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND When quantifying differences in health outcomes between immigrants and non-immigrants, it is common practice to adjust for observed differences in outcome risk factors between the groups being compared. However, as some of these outcome risk factors may act as mediators on the causal path between the exposure and outcome, adjusting for these may remove effects of factors that characterize the immigrants rather than removing a bias between immigrants and non-immigrants. METHODS This study investigates the underlying conditions for which adjusting for outcome risk factors in regression models can lead to the estimation of either total or direct effect for the difference in health outcomes between immigrants and non-immigrants. For this investigation, we use modern tools in causal inference to construct causal models that we believe are highly relevant in an immigrant dataset. In these models, the outcome risk factor is modeled either as a mediator, a selection factor, or a combined mediator/selection factor. Unlike mediators, selection factors are variables that affect the probability of being in the immigrant dataset and may contribute to a bias when comparing immigrants and non-immigrants. RESULTS When the outcome risk factor acts both as a mediator and selection factor, the adjustment for the risk factor in regression models leads to the estimation of what is known as a "controlled" direct effect. When the outcome risk factor is either a selection factor or a mediator alone, the adjustment for the risk factor in regression models leads to the estimation of a total effect or a controlled direct effect, respectively. In all regression analyses, also adjusting for various confounding paths, including mediator-outcome confounding, may be necessary to obtain valid controlled direct effects or total effects. CONCLUSIONS Depending on the causal role of the outcome risk factors in immigrant datasets, regression adjustment for these may result in the estimation of either total effects or controlled direct effects for the difference in outcomes between immigrants and non-immigrants. Because total and controlled direct effects are interpreted differently, we advise researchers to clarify to the readers which types of effects are presented when adjusting for outcome risk factors in immigrant datasets.
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Affiliation(s)
- Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Kari Klungsøyr
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ,grid.418193.60000 0001 1541 4204Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Hein Stigum
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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Nedergaard JB, Nielsen JH, Andersen LMB, Dahl TA, Overgaard C. A kind reminder-A qualitative process evaluation of women's perspectives on receiving a reminder of type 2 diabetes follow-up screening after gestational diabetes. J Eval Clin Pract 2022; 29:591-601. [PMID: 36585792 DOI: 10.1111/jep.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Women with previous gestational diabetes mellitus (GDM) are more than eight times more likely to develop type 2 diabetes (T2DM) compared to women without GDM. Annual follow-up T2DM-screening is recommended, but participation rates decrease rapidly after the first year. In the North Denmark Region, an electronic reminder has been tested with the aim of improving follow-up care for women with prior GDM. The aim of this study was to explore women's perspectives on receiving an electronic reminder, and the role of reminders in both women's decision-making and informed choice regarding participation in follow-up screening. METHODS A qualitative process evaluation informed by a critical realistic perspective. Data consisted of 20 semi-structured interviews with women previously diagnosed with GDM who had received the reminder. Interviews were analyzed using reflexive thematic analysis. RESULTS The reminder affected women's decision-making and informed choices through a range of mechanisms. Its personalized design prompted feelings of co-responsibility and care from the healthcare system, supported continuity in women's care pathways, and helped women bridge the gap between healthcare sectors. Women's perception of diabetes risk and the importance of follow-up influenced their decision-making. Participation in follow-up screening was influenced by several contextual factors, as women's everyday life impeded their prioritizing follow-up screening. Women who experienced being met by their general practitioner (GP) with acknowledgement rather than stigmatization and received supportive information tailored to their life situation were more motivated to participate in future follow-up screenings. CONCLUSION The reminder indicated both concern and co-responsibility for women's follow-up care after GDM and was well received by the women. It supported participation in follow-up screening through an emphasis on shared decision-making and informed choice. Women's interaction with their GP played a significant role.
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Affiliation(s)
- Julie B Nedergaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane H Nielsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark.,Research Center for Health and Applied Technology, University College of Northern Denmark, Aalborg, Denmark
| | - Laerke M B Andersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Tina A Dahl
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Public Health, University of Southern Denmark, Odense, Denmark
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Jiang L, Tang K, Magee LA, von Dadelszen P, Ekeroma A, Li X, Zhang E, Bhutta ZA. A global view of hypertensive disorders and diabetes mellitus during pregnancy. Nat Rev Endocrinol 2022; 18:760-775. [PMID: 36109676 PMCID: PMC9483536 DOI: 10.1038/s41574-022-00734-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.
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Affiliation(s)
- Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Alec Ekeroma
- Department of Obstetrics and Gynecology, Wellington School of Medicine, University of Otago, Wellington, New Zealand
- National University of Samoa, Apia, Samoa
| | - Xuan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Enyao Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
- Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan.
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Dłuski DF, Ruszała M, Rudziński G, Pożarowska K, Brzuszkiewicz K, Leszczyńska-Gorzelak B. Evolution of Gestational Diabetes Mellitus across Continents in 21st Century. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15804. [PMID: 36497880 PMCID: PMC9738915 DOI: 10.3390/ijerph192315804] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Over the last few decades, several definitions of gestational diabetes mellitus (GDM) have been described. There is currently not enough research to show which way is the best to diagnose GDM. Opinions differ in terms of the optimal screening and diagnostic measures, in part due to the differences in the population risks, the cost-effectiveness considerations, and the lack of an evidence base to support large national screening programs. The basic method for identifying the disease is the measurement of glucose plasma levels which may be determined when fasting, two hours after a meal, or simply at any random time. The currently increasing incidence of diabetes in the whole population, the altering demographics and the presence of lifestyle changes still require better methods of screening for hyperglycemia, especially during pregnancy. The main aim of this review is to focus on the prevalence and modifications to the screening criteria for GDM across all continents in the 21st century. We would like to show the differences in the above issues and correlate them with the geographical situation. Looking at the history of diabetes, we are sure that more than one evolution in GDM diagnosis will occur, due to the development of medicine, appearance of modern technologies, and the dynamic continuation of research.
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Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Monika Ruszała
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Gracjan Rudziński
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | - Kinga Pożarowska
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Mardani A, Prinds C, Vaismoradi M. Perinatal and Neonatal Outcomes in Immigrants From Conflict-Zone Countries: A Systematic Review and Meta-Analysis of Observational Studies. Front Public Health 2022; 10:766943. [PMID: 35359776 PMCID: PMC8962623 DOI: 10.3389/fpubh.2022.766943] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives There are controversies regarding the risk of adverse pregnancy outcomes among immigrants from conflict-zone countries. This systematic review and meta-analysis aimed to investigate the risk of perinatal and neonatal outcomes among immigrants from conflict-zone countries compared to native-origin women in host countries. Methods A systematic search on the databases of PubMed/MEDLINE, Scopus, and Web of Science was carried out to retrieve studies on perinatal and neonatal outcomes among immigrants from Somalia, Iraq, Afghanistan, Yemen, Syria, Nigeria, Sudan, Ethiopia, Eritrea, Kosovo, Ukraine, and Pakistan. Only peer-reviewed articles published in the English language were included in the data analysis and research synthesis. The odds ratio and forest plots were constructed for assessing the outcomes of interests using the DerSimonian and Laird, and the inverse variance methods. The random-effects model and the Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results. Results The search process led to the identification of 40 eligible studies involving 215,718 pregnant women, with an immigration background from the conflict zone, and 12,806,469 women of native origin. The adverse neonatal outcomes of the risk of small for gestational age (Pooled OR = 1.8, 95% CI = 1.6, 2.1), a 5-min Apgar score <7 (Pooled OR = 1.4, 95% CI = 1.0, 2.1), stillbirth (Pooled OR = 1.9, 95% CI = 1.2, 3.0), and perinatal mortality (Pooled OR = 2, 95% CI = 1.6, 2.5) were significantly higher in the immigrant women compared to the women of native-origin. The risk of maternal outcomes, including the cesarean section (C-S) and emergency C-S, instrumental delivery, preeclampsia, and gestational diabetes was similar in both groups. Conclusion Although the risk of some adverse maternal outcomes was comparable in the groups, the immigrant women from conflict-zone countries had a higher risk of neonatal mortality and morbidity, including SGA, a 5-min Apgar score <7, stillbirth, and perinatal mortality compared to the native-origin population. Our review results show the need for the optimization of health care and further investigation of long-term adverse pregnancy outcomes among immigrant women.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Christina Prinds
- Department of Clinical Research, University South Denmark, Odense, Denmark
- Department of Midwifery Education, University College South Denmark, Esbjerg, Denmark
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Ogunwole SM, Turkson-Ocran RAN, Boakye E, Creanga AA, Wang X, Bennett WL, Sharma G, Cooper LA, Commodore-Mensah Y. Disparities in cardiometabolic risk profiles and gestational diabetes mellitus by nativity and acculturation: findings from 2016-2017 National Health Interview Survey. BMJ Open Diabetes Res Care 2022; 10:10/1/e002329. [PMID: 35168940 PMCID: PMC8852664 DOI: 10.1136/bmjdrc-2021-002329] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a common complication of pregnancy with implications for cardiovascular health. Among reproductive-aged women, less is known about nativity-related disparities in cardiometabolic risk profiles and GDM history. We examined how cardiometabolic risk profiles and GDM history differed by nativity and explored associations between acculturation, cardiometabolic risk profiles and GDM history. RESEARCH DESIGN AND METHODS We analyzed cross-sectional data from the 2016-2017 National Health Interview Survey among reproductive-aged women (18-49 years) who both reported ever being pregnant and answered the question on GDM history. Using multivariable logistic regression, we examined the percentage with GDM history and compared cardiometabolic profiles by nativity status and acculturation (duration of US residence). RESULTS Of 9525 women, 22.5% were foreign-born. Also, 11.7% of foreign-born women had a GDM history vs 9.6% of US-born women. Foreign-born women with ≥10 years US residence had the highest age-standardized percentage with GDM history (11.0%) compared with US-born women (9.2%) and foreign-born women with <10 years US residence (6.7%). US-born women had a higher prevalence of hypertension, current smoking, and alcohol use than foreign-born women. Among foreign-born women, those with ≥10 years US residence had a higher prevalence of hypertension, current smoking, and alcohol use than those with <10 years US residence. In the fully adjusted model, foreign-born women with ≥10 years US residence had higher odds of GDM history than US-born women (OR 1.43; 95% CI 1.17 to 1.76) while foreign-born women with <10 years US residence and US-born women has similar odds of GDM history. CONCLUSIONS Greater duration of US residence may be associated with nativity-related disparities in GDM. Acculturation, including changing health-related behaviors may explain the disparities among foreign-born women and should be further investigated to appropriately target interventions to prevent GDM and future cardiometabolic diseases.
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Affiliation(s)
- S Michelle Ogunwole
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Ellen Boakye
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yvonne Commodore-Mensah
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Gestational diabetes: changed health beliefs in migrant women from five Asian countries living in Sweden: a prospective qualitative study. Prim Health Care Res Dev 2022; 23:e2. [PMID: 35016742 PMCID: PMC8822325 DOI: 10.1017/s1463423621000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim of this study was to explore the temporal development of beliefs about health, illness and health care in migrant women with gestational diabetes (GD) born in Asia residing in Sweden, and the influence on health-related behaviour in terms of self-care and seeking care. Background: Migrant Asian women are a high-risk group for developing GD. Adapting to the culture in the new society and the healthcare system, being diagnosed with GD and becoming a mother is demanding. The question is whether Asian migrants’ patterns of beliefs and behaviour change over time, as no previous study has been revealed on this topic. Method: Qualitative prospective exploratory study. Semi-structured interviews were held on three occasions: during pregnancy and three and fourteen months after delivery, with women born in Asia, diagnosed with GD. Data were analysed with qualitative content analysis. Findings: There was a temporal change of beliefs influencing health-related behaviour, showing a rising curve in risk awareness. An increasing number of persons described developing a healthy diet/lifestyle based on initial advice and shifted focus from the child to worries about the woman’s health and risk of developing type 2 diabetes and being unable to care for the child/family. Also, the number of women perceiving GD as a transient condition decreased and more believed it would last forever. Beliefs about health care were unchanged, the healthcare model was perceived working well but information about GD and follow-ups was requested even after delivery, and competent staff was expected. Health professionals’ beliefs about the seriousness of GD influence patients’ beliefs and need to be considered. Migrant women need support with adequate information, based on their individual beliefs, to continue develop a sustainable healthy lifestyle even after giving birth, to promote health and prevent type 2 diabetes.
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15
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Li LJ, Huang L, Tobias DK, Zhang C. Gestational Diabetes Mellitus Among Asians - A Systematic Review From a Population Health Perspective. Front Endocrinol (Lausanne) 2022; 13:840331. [PMID: 35784581 PMCID: PMC9245567 DOI: 10.3389/fendo.2022.840331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Since Asians are particularly vulnerable to the risk of gestational diabetes mellitus (GDM), the lifecourse health implications of which are far beyond pregnancy, we aimed to summarize the literature to understand the research gaps on current GDM research among Asians. METHODS We systematically searched the articles in PubMed, Web of Science, Embase, and Scopus by 30 June 2021 with keywords applied on three topics, namely "GDM prevalence in Asians", "GDM and maternal health outcomes in Asians", and "GDM and offspring health outcomes in Asians". RESULTS We observed that Asian women (natives and immigrants) are at the highest risk of developing GDM and subsequent progression to type 2 diabetes among all populations. Children born to GDM-complicated pregnancies had a higher risk of macrosomia and congenital anomalies (i.e. heart, kidney and urinary tract) at birth and greater adiposity later in life. CONCLUSION This review summarized various determinants underlying the conversion between GDM and long-term health outcomes in Asian women, and it might shed light on efforts to prevent GDM and improve the lifecourse health in Asians from a public health perspective. SYSTEMATIC REVIEW REGISTRATION Prospero, CRD42021286075.
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Affiliation(s)
- Ling-Jun Li
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Ling-Jun Li, ; Cuilin Zhang,
| | - Lihua Huang
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, China
| | - Deirdre K. Tobias
- School of Public Health, Harvard University, Boston, MA, United States
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH), Bethesda, MD, United States
- *Correspondence: Ling-Jun Li, ; Cuilin Zhang,
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Leppälä S, Lamminpää R, Gissler M, Vehviläinen-Julkunen K. Prenatal care adequacy of migrants born in conflict-affected countries and country-born parturients in Finland. J Migr Health 2022; 6:100122. [PMID: 35677660 PMCID: PMC9168177 DOI: 10.1016/j.jmh.2022.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Migrants from conflict-affected areas had a 3.5-fold risk for delayed prenatal care. Less prenatal visits prior to term birth compared with country-born parturients. No differences in prepartum hospitalization between migrants and country-born parturients.
Background The 2015 refugee crisis led into a forced migration of millions of people globally. As a consequence, many countries experienced a quick change in the proportion of conflict-area born migrants. This group being stated as an especially vulnerable group for suboptimal maternal health, a timely inspection of preventive maternity care was required. This study investigated prenatal care in terms of gestation trimester at the first prenatal visit, number of check-ups prior to birth, and prepartum hospitalization in conflict-country born migrants and Finnish parturients in Finland. Material and methods Cross-sectional study included all pregnancies of migrants born in conflict-affected countries (n = 3 155) and country-born parturients (n = 93 600) in Finland in 2015–16. The data were obtained through Medical Birth Registry and Population Information System. Statistical analysis employed T-test, Chi-square test, and logistic regression analysis. Odds ratios with 95% Confidence Intervals (CI) were adjusted for sociodemographic and health-related background variables. Results Migrant parturients had a higher probability for delayed enter in prenatal care compared with Finnish-born parturients (adjusted odds ratio aOR = 3.46; 95% Confidence Interval CI 3.06, 3.91). Recommended minimum number of check-ups was participated by 95.3% of the migrant, and 96.4% of the Finnish-born group (P <0.000). Migrants’ probability for more than ten visits prior to term birth was significantly lower (aOR = 0.58; 95% CI 0.51, 0.66). No significant differences in prepartum hospitalization yielded between the groups. Conclusions Migrant parturients had significantly smaller number of check-ups and later entry in care compared with the country-born parturients. These findings add to earlier reported challenges in the organizing of conflict-affected country born migrants’ prenatal care in a high-income setting, in which the proportion of conflict-area born migrants has risen rapidly and unexpectedly.
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Affiliation(s)
- Satu Leppälä
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Corresponding author.
| | - Reeta Lamminpää
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Kuopio University Hospital, Finland
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Kragelund Nielsen K, Andersen GS, Damm P, Nybo Andersen AM. Migration, Gestational Diabetes, and Adverse Pregnancy Outcomes: A Nationwide Study of Singleton Deliveries in Denmark. J Clin Endocrinol Metab 2021; 106:e5075-e5087. [PMID: 34272865 DOI: 10.1210/clinem/dgab528] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT It remains unclear if migrants have different odds for adverse outcomes associated with gestational diabetes mellitus (GDM). OBJECTIVE We investigated if the associations between GDM and adverse pregnancy outcomes are modified by country of origin and examined the odds of these outcomes according to GDM status and country of origin. METHODS Data were extracted from a nationwide register-based study of singleton deliveries in Denmark, 2004-2015. We used logistic regression models and tested for interaction. RESULTS Among the 710 413 singleton deliveries, 2.6% had GDM and 14.4% were immigrants. Country of origin modified the association between GDM and pre-eclampsia, large for gestational age (LGA), and small for gestational age (SGA) but not between GDM and planned or emergency cesarean section and preterm delivery. GDM increased the risk of pre-eclampsia among women from Denmark (OR 1.28; 95% CI, 1.18-1.39), Lebanon (OR 3.34; 95% CI, 1.35-8.26), and Morocco (OR 2.28; 95% CI, 1.16-6.88). GDM was associated with increased odds of LGA among women from most countries, particularly women from Sri Lanka (OR 4.20; 95% CI, 2.67-6.61), and was associated with reduced odds of SGA in some countries. Compared with Danish-born women with GDM, the odds of LGA were significantly lower and the odds of SGA higher among women with GDM from India, Lebanon, Pakistan, Iraq, and Somalia. CONCLUSIONS Our study documents that different immigrant groups have higher odds of different GDM-associated adverse pregnancy outcomes and also among countries of origin often grouped together. This highlights the importance of increased awareness to both immigrant background and GDM status in the clinical assessment.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Steno Diabetes Center Copenhagen, 2820 Gentofte, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Danish Diabetes Academy, 5000 Odense, Denmark
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
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Bagger S, Maindal HT, Nielsen KK, Vrå AG, Aagaard-Hansen J. Perceptions of risk and motivation for healthy living among immigrants from non-western countries with prior gestational diabetes mellitus living in Denmark. Health Psychol Behav Med 2021; 9:761-777. [PMID: 34484976 PMCID: PMC8409963 DOI: 10.1080/21642850.2021.1969235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark. Design Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women were recruited through a public hospital and other health services and nongovernmental organisations. The theoretical approach was inspired by Arthur Kleinman’s Explanatory Models. Data were analysed using qualitative content analysis. Results A diagnosis of GDM entailed great worry for the future. Participants’ fears were primarily linked to the potential later development of type 2 diabetes (T2D) and poor health. Women’s perceptions of GDM reflected their experiences with T2D-related complications and even death among relatives. The risk perception of GDM was also influenced by participants’ challenges and trauma unrelated to diabetes. Their motivation for healthy living was strengthened by their experiences with T2D among relatives, while unrelated challenges and trauma generally reduced their capacity for healthier behaviours. Conclusion Among women with a non-western immigrant background and prior GDM living in Denmark, experiences with T2D among family members and their close communities affect their perceptions of risk and motivation to prevent the development of T2D. Furthermore, the challenges of daily life and past trauma were critical factors in their levels of available resources for health. Health promotion in this population should address health in a holistic way by integrating mental and social health with interventions aimed at preventing the development of T2D.
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Affiliation(s)
- Stine Bagger
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Section for Health Promotion, Aarhus University, Aarhus, Denmark
| | | | | | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Faculty of Health Sciences, SA MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Stupin JH, Henrich W, David M, Schlembach D, Razum O, Borde T, Breckenkamp J. Perinatales Outcome bei Frauen mit Gestationsdiabetes unter besonderer Berücksichtigung eines Migrationshintergrundes – Ergebnisse einer prospektiven Studie in Berlin. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1474-9761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Hintergrund Etwa 25 % der Bevölkerung Deutschlands haben einen Migrationshintergrund (MH), der mit einem schlechteren perinatalen Outcome einhergehen kann. Der Gestationsdiabetes (GDM) gehört zu den häufigsten Schwangerschaftserkrankungen; von ihm sind Frauen mit MH in höherem Maße betroffen. Bisher liegen keine systematisch erhobenen Daten zur Betreuung von Migrantinnen mit GDM vor.
Fragestellung Ziel der Studie war es, Auswirkungen eines MH auf Schwangerschaften von Frauen mit GDM zu evaluieren: Haben Immigrantinnen und ihre Nachkommen ein schlechteres perinatales Outcome als Frauen ohne MH in den Parametern Geburtseinleitung, Sectio, Makrosomie, Apgar, Nabelschnur-pH-Wert, Verlegung auf eine neonatologische Intensivstation, Frühgeburt und prä-/postpartale Hb-Differenz? Beeinflusst ein MH außerdem den Zeitpunkt der ersten Schwangerenvorsorge sowie die Zahl der Vorsorgeuntersuchungen?
Methoden Datenerhebung an drei Berliner Geburtskliniken 2011/2012 unmittelbar in der Kreißsaalaufnahme über 12 Monate anhand standardisierter Interviews (Fragebogenset) in deutscher, türkischer und anderen Sprachen. Fragen zu soziodemografischen Aspekten, Schwangerenvorsorge sowie ggf. Migration und Akkulturation. Verknüpfung der Befragungsdaten mit Mutterpass- und klinischen Perinataldaten. Adjustierung für Alter, BMI, Parität und sozioökonomischen Status erfolgte in Regressionsmodellen.
Ergebnisse Die Daten von n = 2878 Frauen mit MH (GDM: 4,7 %) und n = 2785 Frauen ohne MH (GDM: 4,8 %) konnten verglichen werden. Eine multiple Regressionsanalyse zeigte keine Unterschiede in den Chancen der beiden Gruppen mit GDM hinsichtlich Sectio, Makrosomie, Apgar, Nabelschnur-pH-Werten, Verlegungen auf eine neonatologische Intensivstation sowie Zeitpunkt der ersten Schwangerenvorsorge ≥ 12 SSW und Zahl der Vorsorgeuntersuchungen < 10. Sowohl für Frauen mit GDM und MH (OR 1,57; 95 %-KI 1,08–2,27) als auch für solche mit GDM ohne MH (OR 1,47; 95 %-KI 1,01–2,14) bestand eine signifikant höhere Chance der Geburtseinleitung.
Schlussfolgerung Frauen mit GDM und MH zeigen ein ähnlich gutes Schwangerschaftsergebnis wie solche mit GDM und ohne MH, was auf eine hohe Qualität der peripartalen Betreuung und Versorgung hinweist. Im Vergleich zu Frauen ohne GDM wird bedingt durch diesen und den höheren BMI unabhängig vom MH vermehrt eingeleitet. Die Ergebnisse für Frauen mit GDM lassen unabhängig vom MH auf einen ähnlichen Standard der Inanspruchnahme von Vorsorgeuntersuchungen in der Schwangerschaft schließen.
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Affiliation(s)
| | | | | | | | - Oliver Razum
- AG3 Epidemiology and International Public Health, Universität Bielefeld, Fakultät für Gesundheitswissenschaften, Bielefeld, Germany
| | - Theda Borde
- Public Health, Alice Salomon Hochschule Berlin, Germany
| | - Jürgen Breckenkamp
- AG3 Epidemiology and International Public Health, Universität Bielefeld, Fakultät für Gesundheitswissenschaften, Bielefeld, Germany
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Perception of and Motivation for Physical Activity among Women with a History of Gestational Diabetes. WOMEN 2021. [DOI: 10.3390/women1020010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
(1) Background: Women with a history of gestational diabetes mellitus (GDM) have a high risk of developing type 2 diabetes (T2DM). This risk can be reduced with lifestyle interventions, including physical activity. However, studies have shown that many women with prior GDM are not physically active. The aim of this study was to investigate the motivation for physical activity among women with prior GDM. (2) Methods: A qualitative study was carried out based on a phenomenological approach using semi-structured individual interviews with nine Danish women between 29 and 36 years of age with a minimum of one earlier GDM-affected pregnancy. (3) Results: Five themes were identified; perception of physical activity, risk perception, emotional distress, competing priorities and social support. The perception of physical activity varied among the women. The GDM diagnosis or the awareness of elevated risk for T2DM did not seem to be a decisive factor for the women’s motivation to be active. Competing priorities, including being in control of everyday life choices and support from social relations, were found to be important motivational factors. (4) Conclusion: Future interventions for women with prior GDM to increase motivation for physical activity should be compatible with and take into account the women’s perceptions, earlier lived experiences, possible competing priorities and support systems.
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Strandberg RB, Iversen MM, Jenum AK, Sørbye LM, Vik ES, Schytt E, Aasheim V, Nilsen RM. Gestational diabetes mellitus by maternal country of birth and length of residence in immigrant women in Norway. Diabet Med 2021; 38:e14493. [PMID: 33290601 DOI: 10.1111/dme.14493] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
AIMS Immigrant women are at higher risk for gestational diabetes mellitus (GDM) than non-immigrant women. This study described the prevalence of GDM in immigrant women by maternal country of birth and examined the associations between immigrants' length of residence in Norway and GDM. METHODS This Norwegian national population-based study included 192,892 pregnancies to immigrant and 1,116,954 pregnancies to non-immigrant women giving birth during the period 1990-2013. Associations were reported as odds ratios (ORs) with 95% confidence intervals (CIs) using logistic regression models, adjusted for year of delivery, maternal age, marital status, health region, parity, education and income. RESULTS The prevalence and adjusted OR [CI] for GDM were substantially higher in immigrant women from Bangladesh (7.4%, OR 8.38 [5.41, 12.97]), Sri Lanka (6.3%, OR 7.60 [6.71, 8.60]), Pakistan (4.3%, OR 5.47 [4.90, 6.11]), India (4.4%, OR 5.18 [4.30, 6.24]) and Morocco (4.3%, OR 4.35 [3.63, 5.20]) compared to non-immigrants (prevalence 0.8%). Overall, GDM prevalence increased from 1.3% (OR 1.25 [1.14, 1.36]) to 3.3% (OR 2.55 [2.39, 2.71]) after 9 years of residence in immigrants compared to non-immigrant women. This association was particularly strong for women from South Asia. CONCLUSIONS Gestational diabetes mellitus prevalence varied substantially between countries of maternal birth and was particularly high in immigrants from Asian countries. GDM appeared to increase with longer length of residence in certain immigrant groups.
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Affiliation(s)
- Ragnhild B Strandberg
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Linn Marie Sørbye
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - Eline S Vik
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Erica Schytt
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Read SH, Rosella LC, Berger H, Feig DS, Fleming K, Ray JG, Shah BR, Lipscombe LL. BMI and risk of gestational diabetes among women of South Asian and Chinese ethnicity: a population-based study. Diabetologia 2021; 64:805-813. [PMID: 33486538 DOI: 10.1007/s00125-020-05356-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/22/2020] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine how BMI influences the association between Asian ethnicity and risk of gestational diabetes (GDM). METHODS This population-based cohort study included pregnant women without pre-existing diabetes mellitus in Ontario, Canada between 2012 and 2014. Women of Chinese and South Asian ethnicity were identified using a validated surname algorithm. GDM was ascertained using hospitalisation codes. The relationship between ethnicity and GDM was modelled using modified Poisson regression, adjusted for maternal age, pre-pregnancy BMI, parity, previous GDM, long-term residency status, income quintile and smoking status. An interaction term between ethnicity and pre-pregnancy BMI was tested. RESULTS Of 231,618 pregnant women, 9289 (4.0%) were of South Asian ethnicity and 12,240 (5.3%) were of Chinese ethnicity. Relative to women from the general population, in whom prevalence of GDM was 4.3%, the adjusted RR of GDM was higher among those of South Asian ethnicity (1.81 [95% CI 1.64, 1.99]) and Chinese ethnicity (1.66 [95% CI 1.53, 1.80]). The association between GDM and Asian ethnicity remained significant across BMI categories but differed according to BMI. The prevalence of GDM exceeded 5% at an estimated BMI of 21.5 kg/m2 among South Asian women, 23.0 kg/m2 among Chinese women and 29.5 kg/m2 among the general population. CONCLUSIONS/INTERPRETATION The risk of GDM is significantly higher in South Asian and Chinese women, whose BMI is lower than that of women in the general population. Accordingly, targeted GDM prevention strategies may need to consider lower BMI cut-points for Asian populations.
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Affiliation(s)
- Stephanie H Read
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Laura C Rosella
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Howard Berger
- Division of Maternal-Fetal Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Denice S Feig
- ICES, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - Karen Fleming
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Joel G Ray
- ICES, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynaecology, St Michael's Hospital, Toronto, ON, Canada
| | - Baiju R Shah
- ICES, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis? J Clin Med 2021; 10:jcm10061196. [PMID: 33809287 PMCID: PMC7999215 DOI: 10.3390/jcm10061196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
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Wang M, Hu RY, Gong WW, Pan J, Fei FR, Wang H, Zhou XY, Zhong JM, Yu M. Trends in prevalence of gestational diabetes mellitus in Zhejiang Province, China, 2016-2018. Nutr Metab (Lond) 2021; 18:12. [PMID: 33468171 PMCID: PMC7814615 DOI: 10.1186/s12986-020-00539-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Limited population-based studies have investigated the secular trend of prevalence of gestational diabetes mellitus (GDM) in mainland China. Therefore, this study aimed to estimate the prevalence of GDM and time trends in Chinese female population. Methods Based on Diabetes Surveillance System of Zhejiang Province, 97,063 diagnosed GDM cases aged 20–50 years were identified from January 1, 2016 to December 31, 2018. Annual prevalence, prevalence rate ratios (PRRs) and average annual percentage change with their 95% confidence intervals (CIs) were reported. Results The age-standardized overall prevalence of GDM was reported to be 7.30% (95% CI 7.27–7.33%);
9.13% (95% CI 9.07–9.19%) in urban areas and 6.24% (95% CI 6.21–6.27%) in rural areas. Compared with 20–24 years age group, women in advanced age groups (25–50 years) were at higher risk for GDM (PRRs ranged from 1.37 to 8.95 and the 95% CIs did not include the null). Compared with rural areas, the risk for GDM was higher in urban areas (PRR: 1.69, 95% CI 1.67–1.72). The standardized annual prevalence increased from 6.02% in 2016 to 7.94% in 2018, with an average annual increase of 5.48%, and grew more rapidly in rural than urban areas (11.28% vs. 0.00%). Conclusions This study suggested a significant increase in the prevalence of GDM among Chinese female population in Zhejiang province during 2016–2018, especially in women characterized by advanced age and rural areas.
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Affiliation(s)
- Meng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Ru-Ying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Wei-Wei Gong
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jin Pan
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Fang-Rong Fei
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Hao Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Xiao-Yan Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jie-Ming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China.
| | - Min Yu
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China.
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Dalla Zuanna T, Cacciani L, Barbieri G, Ferracin E, Zengarini N, Di Girolamo C, Caranci N, Petrelli A, Marino C, Agabiti N, Canova C. Avoidable hospitalisation for diabetes mellitus among immigrants and natives: Results from the Italian Network for Longitudinal Metropolitan Studies. Nutr Metab Cardiovasc Dis 2020; 30:1535-1543. [PMID: 32611534 DOI: 10.1016/j.numecd.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Italy has experienced a relevant increase in migration inflow over the last 20 years. Although the Italian Health Service is widely accessible, immigrants can face many barriers that limit their use of health services. Diabetes mellitus (DM) has a different prevalence across ethnic groups, but studies focusing on DM care among immigrants in Europe are scarce. This study aimed to compare the rates of avoidable hospitalisation (AH) between native and immigrant adults in Italy. METHODS AND RESULTS A multi-centre open cohort study including all 18- to 64-year-old residents in Turin, Venice, Reggio-Emilia, Modena, Bologna and Rome between 01/01/2001 and 31/12/2013-14 was conducted. Italian citizens were compared with immigrants from high migratory pressure countries who were further divided by their area of origin. We calculated age-, sex- and calendar year-adjusted rate ratios (RRs) and 95% confidence intervals (95% CIs) of AH for DM by citizenship using negative binomial regression models. The RRs were summarized using a random effects meta-analysis. The results showed higher AH rates among immigrant males (RR: 1.63, 95% CI: 1.16-2.23), whereas no significant difference was found for females (RR: 1.14, 95% CI: 0.65-1.99). Immigrants from Asia and Africa showed a higher risk than Italians, whereas those from Central-Eastern Europe and Central-Southern America did not show any increased risk. CONCLUSION Adult male immigrants were at higher risk of experiencing AH for DM than Italians, with differences by area of origin, suggesting that they may experience lower access to and lower quality of primary care for DM. These services should be improved to reduce disparities.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy.
| | - Laura Cacciani
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
| | - Elisa Ferracin
- Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy
| | - Nicolas Zengarini
- Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy
| | - Chiara Di Girolamo
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Claudia Marino
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35131 Padova, Italy
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