Endocrine Abstracts

Background: Lifestyle interventions as well as pharmacological therapy are strong measures to prevent adverse pregnancy and birth outcomes in women with gestational diabetes (GDM). Social determinants of health and consequent health disparities can affect a successful GDM management. This includes inequality in health care and education quality, economic stability as well as environmental factors. However, in high-income countries, these social determinants of health have rarely been studied even though gestational diabetes prevalences as well as social inequities are a rising health care problem.

Aim: Therefore, our aim is to investigate whether the association between GDM and adverse maternal outcomes is modified by insurance classes, regional area, or citizenship.

Methods: This is a population-based retrospective cohort study, using Swiss claims data from the Federal Statistical Office from January 2012 to December 2021. All delivery hospitalisations in Swiss hospitals were included and stratified according to maternal gestational diabetes status. The primary endpoint is a composite endpoint of adverse pregnancy (hypertensive disorders), delivery (induction of labor, instrumental or surgical delivery, obstetric traumata, other complications) and puerperal (infections, venous complications, other complications) outcomes defined by ICD-10 and CHOP codes. Secondary outcomes are the single components of the primary outcome.

Results: Of the identified 850, 414 delivery hospitalisations between 2012 and 2021, 7.3% of the pregnancies were affected by GDM. Women with GDM were more likely to be publicly insured, more often born outside of Switzerland and lived more often in a region with a high urban population. GDM patients had higher risk of an adverse obstetric outcome overall (OR 1.14, 95% CI 1.12-1.16). This association remained stable in the citizenship or insurance status subgroups but not in the regional area subgroup where we found a more pronounced association in women living in a canton with higher proportion of rural population (rural canton OR 1.18, 95% CI 1.14-1.23 vs urban canton OR 1.12, 95% CI 1.11-1.15, P for interaction 0.043).

Conclusion: We found no evidence for health disparity in relation to insurance status and citizenship in Switzerland. If there is no treatment inequality or if these variables are not adequate proxies for health disparities remains unknown. The finding that women from a more rural canton were at higher risk for GDM-related outcomes might be of importance in further improving nation-wide GDM care.