Association of ethnicity and socioeconomic status with health outcomes in women with gestational diabetes: Clinical practice research datalink cohort study

Aims: To investigate in women with prior gestational diabetes mellitus (GDM), differences by ethnicity and socioeconomic status in the incidence of recurrent GDM, type 2 diabetes (T2D), hypertension, and depression. Methods: This was a retrospective cohort study including 10,868 women diagnosed with GDM in the Clinical Practice Research Datalink (CPRD GOLD) between January 01, 2000 and November 05, 2018. Linked data were obtained for Hospital Episode Statistics and the Index of Multiple Deprivation. We estimated incidence rates and hazard ratios, by ethnicity and socioeconomic status. Results: During a follow-up of 58,479 person years (mean (SD): 5.38 (3.67) years), the crude incidence was 9.67 (95 % confidence interval: 9.30 -10.00) per 100 person years for recurrent GDM, 3.86 (3.70 -4.02) for depression, 2.15 (2.03 -2.27) for T2D and 0.89 (0.81 -0.97) for hypertension. South Asian ethnicity was associated with an increased risk of T2D compared to White (adjusted hazard ratio: 1.65; 1.34 -2.05) and Black ethnicity was associated with a greater risk of hypertension (2.93; 1.93 -4.46). Black and South Asian ethnicity were associated with a reduced risk of depression compared to White: 0.23 (0.13 -0.39) and 0.37 (0.29 -0.46), respectively. Incidence rates were higher for all conditions with increasing deprivation level. Conclusions: The risk of health complications in women with a prior history of GDM differs by ethnicity and socioeconomic status, suggesting the opportunity for targeted assessment in the years following pregnancy. These findings may inform future guidelines on screening for health outcomes in women with GDM.