Outcome of Pregnancy Among Immigrant Women With Diabetes

Outcome of Pregnancy Among Immigrant Women With Diabetes Siri Vangen , MD 1 2 , Camilla Stoltenberg , PHD, MD 1 , Synne Holan , RN, RM 3 , Narve Moe , PHD, MD 2 , Per Magnus , PHD, MD 1 , Jennifer R. Harris , PHD 1 and Babill Stray-Pedersen , PHD, MD 2 1 Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway 2 Department of Obstetrics and Gynaecology, the National Hospital, Oslo, Norway 3 Department of Obstetrics, Aker University Hospital, Oslo, Norway Abstract OBJECTIVE —We studied outcome of pregnancy among immigrant women with diabetes. The women came from regions of the world with high incidence of impaired glucose tolerance and type 2 diabetes. Prevalences, secular trends, and sociodemographic risk factors of diabetes were also explored. RESEARCH DESIGN AND METHODS —Data from the Medical Birth Registry of Norway on all births from 1988 to 1998 for mothers born in South Asia and North Africa (11,268) and Norway (601,785) were analyzed. RESULTS —The prevalence of pregestational diabetes among the immigrants was 8.9/1,000 births, which was more than twice the rate among ethnic Norwegians (3.6/1,000). Time trends indicated increasing prevalences in both groups. Among the immigrants, diabetes was closely associated with maternal age. Maternal diabetes was associated with a significantly increased risk of pregnancy complications in both study groups. Increased risks were found for low birth weight, macrosomia, preterm birth, preeclampsia, and cesarean sections. Among ethnic Norwegians, maternal diabetes conferred a significantly increased risk of infant perinatal death (odds ratio 2.00, 95% CI 1,44–2.77). In the sample of immigrant women with predominantly type 2 diabetes, maternal diabetes was not significantly associated with perinatal death or congenital malformations in the offspring. CONCLUSIONS —The high prevalence of diabetes among immigrants from South Asia and North Africa represents a challenge for health care providers. To prevent adverse pregnancy outcomes and later cardiovascular and renal morbidity among these groups, early diagnosis of diabetes, adequate metabolic control, and relevant preventive measures are warranted. Footnotes Address correspondence and reprint requests to Siri Vangen, Division of Epidemiology, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway. E-mail: siri.vangen{at}fhi.no . Received for publication 23 April 2002 and accepted in revised form 5 November 2002. A table elsew