Maternal and neonatal outcomes in migrant women with gestational diabetes. A retrospective cohort study in Italy.

BACKGROUND

Migrant women have a higher risk of gestational diabetes (GDM), and often poorer metabolic control during pregnancy. However, evidence on neonatal outcomes compared to Italian women is limited and inconsistent. This study aimed to compare neonatal outcomes between migrant and Italian women, and to identify predictors of adverse outcomes.

METHODS

Clinical and metabolic data of pregnant women, who underwent selective screening (based on risk factors) for GDM at the University Hospital of Pisa from 2014 to 2022, were retrospectively collected. Neonatal outcomes (preterm delivery, large (LGA) and small (SGA) for gestational age, caesarean delivery, Apgar score 5') were compared between Italian and migrant women, with a specific focus on high-risk ethnic groups.

RESULTS

Among 3499 women (78% Italian and 22% non-Italian), 1419 (41%) had GDM. Neonatal outcomes were comparable between Italian and migrant women, both in the whole cohort and in the subgroup with GDM. However, women with high-risk ethnicity reported a higher rate of SGA infants, both overall (12% vs. 7%, p = 0.001) and in the GDM subgroup (11% vs. 6%, p = 0.046), without significant differences in the Ponderal Index. At multivariable analysis, high-risk ethnicity was independently associated with an almost twofold increased risk of SGA (OR: 1.843 [1.196-2.838], p = 0.006).

CONCLUSIONS

Close monitoring during gestation, management by a multidisciplinary team and free access to healthcare services may explain the similarity of neonatal outcomes in Italian and migrant women. The lack of ethnic-specific guidelines for fetal growth may explain the greater risk of SGA among women with high-risk ethnicity.