Refugee women with gestational diabetes who resettled in Ontario, Canada, had a 23% higher risk for developing incident postpartum type 2 diabetes after 4 years vs. nonimmigrants who had gestational diabetes, according to findings published in Diabetic Medicine.
In an analysis of three Canadian population-based health databases, researchers also found that, compared with nonimmigrant women with gestational diabetes, refugee women had similar or lower rates of gestational diabetes-associated adverse outcomes, including preeclampsia, preterm birth, macrosomia, respiratory distress syndrome and neonatal hyperbilirubinemia.
“These results suggest that despite their different circumstances and impetuses leading to immigration, refugees and other immigrants have a similar ‘healthy immigrant effect,’ at least with regards to [gestational diabetes]-associated adverse outcomes,” Baiju Shah, MD, PhD, associate professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto, and colleagues wrote. “This observation is somewhat surprising, because refugees are often more economically deprived than other immigrants and are at greater risk of previous exposure to harmful living conditions, violence and trauma — all factors which contribute to poor health outcomes.”
Shah and colleagues analyzed data from 40,902 women with gestational diabetes, including 2,106 refugees and 16,232 other immigrants, linking data from the Institute for Clinical Evaluation Sciences, the Ontario Diabetes Database and the Permanent Resident Database of Immigration, Refugees and Citizenship Canada, which contains records for all immigrants to Ontario since 1985. Women with singleton live births between April 2002 and March 2014 were included. The cohort was then stratified by three groups based on immigration class: refugees, other immigrants and nonimmigrants (including any long-term immigrants who migrated before 1985). Women were followed through March 2014 for a diagnosis of type 2 diabetes using the Ontario Diabetes Database (median follow-up time, 4 years). Researchers used Cox proportional hazard models to compare between-group incidence rates for type 2 diabetes after pregnancy.
Researchers found that gestational diabetes-related adverse outcomes occurred at lower or similar rates for refugee women compared with nonimmigrant women; results persisted after adjustment for age, parity, socioeconomic status and pregestational hypertension. Other immigrants similarly had no increased risk for adverse outcomes compared with nonimmigrants, except for a higher rate of low birth weight and neonatal hypoglycemia, the researchers wrote.
Compared with nonimmigrants, refugees and other immigrants with gestational diabetes were more likely to attend endocrinology visits in late pregnancy. However, refugees and other immigrants were less likely to attend a well-baby care visit between 45 and 75 days after birth compared with nonimmigrants.
The crude incidence rate of diabetes after delivery was 45.6 per 1,000 person-years among refugees, compared with 37.2 for other immigrants and 34.3 for nonimmigrants. Refugee women with gestational diabetes had a 23% increased risk for incident diabetes (HR = 1.23; 95% CI, 1.11-1.37) during follow-up, whereas other immigrants had only a slightly higher risk for developing incident diabetes vs. nonimmigrants (HR = 1.06; 95% CI, 1.01-1.12).
“Despite having different circumstances leading to migration than other immigrants, refugees who successfully immigrate to another country are self-selected to be healthy individuals, which contributes to their lower risk for adverse [gestational diabetes] outcomes,” the researchers wrote. “However, their worse outcomes after pregnancy suggest that better preventative and public health strategies are needed to maintain this health advantage.”
Disclosures: The authors report no financial disclosures.
From www. healio.com
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