Ethnicity and Immigration Status as Risk Factors for Gestational Diabetes Mellitus, Anemia and Pregnancy Outcomes Among Food Insecure Women Attending the Montreal Diet Dispensary Program

• Published in: Canadian journal of diabetes 2020-03, Vol.44 (2), p.139-145.e1
• Main Authors: Ménard, Véronique, Sotunde, Olusola F., Weiler, Hope A.
• Format: Article
• Language: English
• Subjects: Adult; Anemia - epidemiology; Continental Population Groups - statistics & numerical data; Diabetes, Gestational - epidemiology; disparités en santé; DSG; ethnicity; ethnicité; faible revenu; Female; Food Insecurity; GDM; Gestational Weight Gain - ethnology; health disparities; Humans; issues de la grossesse; low income; Poverty; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Outcome - epidemiology; Pregnancy Outcome - ethnology; pregnancy outcomes; Quebec; Risk Factors; Young Adult
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/j.jcjd.2019.05.004

The primary aim of this study was to characterize the rate of adverse pregnancy outcomes in a multicultural group of low-income women. Data were extracted from the Montreal Diet Dispensary's database between June 2013 and December 2015. Risk was evaluated using logistic regression adjusted for covariates. Of the 1,387 pregnancies, the prevalence of gestational diabetes mellitus (GDM) was 17.2% (95% confidence interval [CI], 15.1% to 19.3%), maternal anemia 44.9% (95% CI, 41.9% to 47.9%) and hypertension 3.8% (95% CI, 2.8% to 4.8%). The prevalence of small-for-gestational-age infants was 5.5% (95% CI, 4.3% to 6.7%), preterm births 4.7% (95% CI, 3.6% to 5.9%), low birthweight 4.2% (95% CI, 3.1% to 5.2%) and large-for-gestational-age infants was 10.6% (95% CI, 9.0% to 12.2%). Asian women had an increased odds of gestational diabetes mellitus (adjusted odds ratio [aOR], 1.86; 95% CI, 1.17 to 2.98) and SGA infants (aOR, 2.35; 95% CI 1.21 to 4.57) compared with white women. Anemia was more likely for black women compared with white women (aOR, 1.74; 95% CI, 1.29 to 2.35). Black women were more at risk of preterm birth (aOR, 1.79; 95% CI, 1.01 to 3.19). Immigrants showed an increased risk of maternal anemia compared with Canadian-born women (aOR, 1.85; 95% CI, 1.06 to 3.21). As disparities in maternal and infant outcomes were present, nutritional intervention(s) need to be targeted toward prevention of adverse pregnancy outcomes, prioritization of higher-risk groups and adaptation of the program to a multiethnic low-income population. La présente étude a pour objectif principal de caractériser le taux d'issues de grossesse indésirables dans un groupe multiculturel composé de femmes à faible revenu. Les données extraites entre juin 2013 et décembre 2015 provenaient de la base de données du Dispensaire diététique de Montréal. Le risque a été évalué au moyen d'un modèle de régression logistique ajusté sur les covariables. Parmi les 1387 femmes enceintes, la prévalence du diabète sucré gestationnel (DSG) était de 17,2 % (intervalle de confiance [IC] à 95 %, de 15,1 % à 19,3 %), l'anémie maternelle, de 44,9 % (IC à 95 %, de 41,9 % à 47,9 %) et l'hypertension maternelle, de 3,8 % (IC à 95 %, de 2,8 % à 4,8 %). La prévalence d'enfants de faible poids pour l’âge gestationnel (FPAG) était de 5,5 % (IC à 95 %, de 4,3 % à 6,7 %), les naissances prématurées, de 4,7 % (IC à 95 %, de 3,6 % à 5,9 %), le faible poids à la naissance, de 4,2 % (IC à 95 %, de 3,1 % à 5,2 %) et les