• Gestational diabetes is more prevalent in women from lower socio-economic backgrounds.

      Owens, L; Cullinane, J; Gillespie, P; Avalos, G; O'Sullivan, EP; Dennedy, C; O'Sullivan, EP; O'Reilly, M (Diabetic Pregnancy Study Group, 2011)
      The link between socio-economic disadvantage and poor health has been observed across many spectrums of medicine. There is little evidence however, suggesting that Diabetes in Pregnancy is more prevalent in women from poorer backgrounds. This study was completed by the Atlantic Diabetes in Pregnancy partnership, which offered universal screening for Gestational Diabetes at 24-28 weeks gestation. Data was collected on women who delivered in 5 antenatal centres between 2007 and 2009. The calculated socio-economic background is based on a deprivation index derived from area of residence and national census data. The Deprivation Index is scored from 1-5, from least to most deprived, using various indicators; education, employment, percentage skilled/unskilled workers, demographic information, lone parents and number of persons/room. Using a ‘bivariate probit with sample selection’ model we controlled for poor attendance amongst women from disadvanted areas. We found that incidence of gestational diabetes is significantly higher for women living in the poorest areas, compared to women living in the richest areas. This gradient disappears when diabetes risk factors are controlled for, suggesting personal, clinical and lifestyle factors correlated with socioeconomic status are significant determinants for the development of Gestational Diabetes. These risk factors include; Body Mass Index, family history, smoking, sedentary lifestyle and higher immigrant population. Gestational Diabetes is more prevalent amongst women from lower socio-economic backgrounds.
    • Gestational diabetes mellitus results in a higher prevalence of small for gestational age babies

      Avalos, G; Owens, LA; Dennedy, C; O'Sullivan, EP; O'Reilly, MW; Dunne, F; Department of Medicine, National University of Ireland, Galway, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09)
      Background and aims: Gestational Diabetes Mellitus (GDM) is associated with increased foetal and maternal morbidity and mortality. Previous studies have shown that babies of diabetic mothers are more likely to be large for gestational age (LGA). This retrospective study aimed to assess whether the converse may also be true, that there may also a higher rate of small for gestational age (SGA) amongst babies of mothers with GDM. Materials and methods: This retrospective study offered universal screening for GDM to pregnant women in 5 hospitals between 2007-2009. During this time 5,500 women underwent testing for GDM using a 75g Oral Glucose Tolerance Test at 24-28 weeks gestation. GDM was defined by the International Association of the Diabetes and Pregnancy Study Groups guidelines (IADPSG). Results: The prevalence of GDM was 12.4%. 4.5% of babies were small for gestational age (SGA) at birth in live births. Babies of mothers with GDM were more likely to have SGA than babies of non-diabetic women, OR 1.5, p=0.03, 95% CI {1.02-2.24. Mean Body Mass Index (BMI) was lower in mothers of SGA babies than mothers of babies who were average (AGA) or large for gestational age (LGA), 26.3 compared to 27.1, p<0.0001. Smoking (OR 3.1, p=0.000)) pre-ecampsia (OR 3.99,p=0.000), gestational hypertension, low parity (OR 0.8.p= 0.005), non-Caucasion ethnicity were also predictive of SGA These SGA babies had a worse clinical outcome, including; higher caesarean section rate, higher requirement for neonatal intensive care , higher rates of hypoglycaemia and respiratory distress. 76% of diabetic women were treated with insulin. Insulin treatment did not affect rates of SGA when compared with dietary management. Conclusion: This study shows another important negative outcome associated with GDM. Further research is required to identify the causative factor(s).
    • Gestational diabetes mellitus results in a higher prevalence of small for gestational babies

      Dunne, F; Owens, LA; Avalos, G; Dennedy, C; O'Sullivan, EP; O'Reilly, M; Department of Medicine, National University of Ireland, Galway, Galway, Ireland. (Diabetic Study Pregnancy Group (DSPG), 2011)
      Background and aims: Gestational Diabetes Mellitus (GDM) is associated with increased foetal and maternal morbidity and mortality. Previous studies have shown that babies of diabetic mothers are more likely to be large for gestational age (LGA). This retrospective study aimed to assess whether the converse may also be true, that there may also a higher rate of small for gestational age (SGA) amongst babies of mothers with GDM. Materials and methods: This retrospective study offered universal screening for GDM to pregnant women in 5 hospitals between 2007-2009. During this time 5,500 women underwent testing for GDM using a 75g Oral Glucose Tolerance Test at 24-28 weeks gestation. GDM was defined by the International Association of the Diabetes and Pregnancy Study Groups guidelines (IADPSG). Results: The prevalence of GDM was 12.4%. 4.5% of babies were small for gestational age (SGA) at birth in live births. Babies of mothers with GDM were more likely to have SGA than babies of non-diabetic women, OR 1.5, p=0.03, 95% CI {1.02-2.24}. Mean Body Mass Index (BMI) was lower in mothers of SGA babies than mothers of babies who were average (AGA) or large for gestational age (LGA), 26.3 compared to 27.1, p<0.0001. Smoking (OR 3.1, p=0.000)) pre-eclampsia (OR 3.99,p=0.000) , low parity (OR 0.8.p= 0.005), non- Caucasian ethnicity were also predictive of SGA These SGA babies had a worse clinical outcome, including; higher caesarean section rate, higher requirement for neonatal intensive care , higher rates of hypoglycaemia and respiratory distress. 76% of diabetic women were treated with insulin. Insulin treatment did not affect rates of SGA when compared with dietary management. Conclusion: This study shows another important negative outcome associated with GDM. Further research is required to identify the causative factor(s).
    • Investigating the role of healthcare accessibility and socio-economic background on the decision to attend for screening for gestational diabetes mellitus in Ireland

      Owens, L; Cullinane, J; Gillespie, P; Avalos, G; O'Sullivan, EP; O'Reilly, M; Dennedy, C; Dunne, F; Department of Medicine, National University of Ireland, Galway 2Department of Economics, National University of Ireland, Galway (Diabetic Pregnancy Study Group, 2011)
      Gestational diabetes mellitus (GDM) is associated with increased maternal and neonatal morbidity and mortality. We investigated the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems (GIS), econometric and simulation techniques. In particular, we focus on the extent to which ‘travel distance to screening site’ impacts upon the individual’s screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level. We also aimed to assess whether Irish women of lower socio-economic status were less likely to attend for screening for Diabetes in Pregnancy than their higher status counterparts. This study was completed through the Atlantic Diabetes in Pregnancy (DIP) partnership, which offers universal screening for Gestational Diabetes at 24-28 weeks gestation. Data was collected on all women who delivered in 5 antenatal centres along the Irish Atlantic Seaboard between 2007-2009. Patients were ‘geocoded’, in order to provide precise spatial (x,y) coordinates for their residential locations. This facilitates geographic information systems -based route analysis of travel distances for each individual to their nearest screening site. We then model the decision to attend for screening, where control variables include travel distance to screening site, a range of other site accessibilityrelated variables, as well as a number of individual-level variables relating to personal, socioeconomic, clinical and lifestyle characteristics. The socio-economic status is based on the deprivation score derived from the 2006 Census of Population for the Republic of Ireland. The Deprivation Index is constructed from a combination of various indicators; education, employment, percentage skilled/unskilled workers, demographic information, lone parents and number of persons/room. 9,043 pregnant women offered screening, 5,218 (58%) of whom participated in testing. The probability of attending for screening was reduced by 1.8% [95% CI: 1.3% to 2.3%] for every additional 10kms required to travel for screening (p=0.000). We also find significant variation in uptake rates across hospitals after controlling for travel distance and other factors, suggesting that accessibility and quality-of-service are also important determinants of overall uptake rates. Using the deprivation index 60% of those who scored 1 (most affluent) attended for screening, 58% in score 2, 56% in score 3, 53% in score 4 and 46% in the score 5 (most deprived) group attended, p=0.0001. This shows a clear decrease in attendance levels in those who are deemed to be more disadvantaged. The most disadvantaged women overall were 40% less likely to attend than their most affluent counterparts (OR0.6, 95%CI {0.55-0.71},p=0.001). Accessibility to healthcare centres and socio-economic background both affect the decision to attend for screening for Gestational Diabetes Mellitus in Ireland.
    • Screening complications and treatment of Gestational Diabetes

      Dennedy, C; O'Sullivan, E; Dunne, F (Diabetes and Primary Care, 2010)
    • Screening complications and treatment of gestational diabetes.

      Dennedy, C; O Sullivan, E; Dunne, F (Diabetes and Primary Care, 2010)