Outcomes of gestational diabetes in Sweden depending on country of birth

Objective. To analyze maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden, depending on country of birth (Nordic vs. non-Nordic women). Design. Population-based cohort study using the Swedish Medical Birth register. Setting. Data on pregnant women in Sweden with diagnosed GDM. Population. All singleton births to women with GDM between 1998 and 2007 (n = 8560). Methods. Logistic regression in an adjusted model to assess the risk of adverse maternal and neonatal outcomes. Chi-squared tests or Student's unpaired t-tests were used to analyze differences between maternal and fetal characteristics. Main outcome measures. Maternal and neonatal complications. Results. GDM incidence was higher at 2.0% among non-Nordic women, compared with 0.7% in the Nordic group. The non-Nordic women were older, had less chronic hypertensive disease, smoked less, and had lower BMI and shorter height. Preeclampsia was significantly lower in the non-Nordic group. The mean birthweight (3561 vs. 3698 g, p < 0.001) and the large-for-gestational age rate (11.7 vs. 17.5%, p < 0.001) were significantly lower in the non-Nordic group. Large-for-gestational age was dependent on maternal height [crude odds ratio 0.6 (0.50.7) and adjusted odds ratio 0.8 (0.60.9)]. Conclusions. Non-Nordic women with GDM in Sweden have better obstetrical and neonatal outcomes than Nordic women. These results do not support the idea of inequality of health care. Large-for-gestational age as a diagnosis is highly dependent on maternal height, which raises the question of the need for individualized growth curves.