Pregnancy Outcomes in Women with Type 1 Diabetes by Socioeconomic and Mental Health Disadvantages.

AIM: To examine whether individual-level measures of socioeconomic or mental health disadvantages are associated with preterm delivery and extreme large for gestational age (eLGA) among women with type 1 diabetes.

METHODS

Nationwide register-based study of singleton pregnancies among women with type 1 diabetes, 1997-2021. Disadvantages included family poverty (disposable income <50% of national median) and, for either parent, low educational level (≤primary school), unemployment (cash/disability benefits), or poor mental health (≥1 prepregnancy psychiatric diagnosis). Outcomes were preterm delivery (<37 weeks) and eLGA (birthweight ≥97.5th percentile). We estimated absolute risk (AR) and crude and adjusted relative risks (aRR), adjusting for parental immigration status and maternal birth year. Sensitivity analyses were stratified by prepregnancy HbA1c (<53/≥53 mmol/mol).

RESULTS

Among 5478 pregnancies, AR of preterm delivery and eLGA were 32.5% and 36.0%, respectively, and 40.1% experienced ≥1 disadvantage, ranging from 5.6% having family poverty to 18.9% having low paternal educational level. Higher aRRs of preterm delivery were found across all measures of disadvantage, ranging from 1.23 (1.00;1.45) to 1.48 (1.28;1.68). We observed a non-significant trend toward lower risk of eLGA with all disadvantages (aRRs ranging from 0.82 (0.64;1.00) to 1.01 (0.84;1.18)). Stratification by prepregnancy HbA1c showed basically unchanged aRRs but widened confidence intervals.

CONCLUSION

Among women with type 1 diabetes, socioeconomic or mental health disadvantages were associated with higher risk of preterm delivery, but not eLGA, regardless of prepregnancy HbA1c level. These findings underscore the need for targeted interventions to address social and mental health disparities in order to reduce preterm birth risk among women with type 1 diabetes.