Social inequalities in gestational diabetes prevalence and complication burden: a nationwide Swedish cohort study

While studies from other settings have shown associations between social determinants of health (SDOH) and GDM, evidence remains limited in high-income, equity-oriented healthcare settings.

To examine the association between SDOH, GDM and GDM-related complications in Sweden.

Retrospective cohort study.

Nationwide registry data linked across multiple population-based registries.

938,798 singleton pregnancies.

GDM, with effect modification by region of birth, education and income.

Number of pregnancy, obstetric, postpartum and neonatal complications.

The prevalence of GDM increased from 1.5% to 6.6% between 2015-2023, with the steepest increases observed among individuals with foreign-born origin, lower education, and lower income. While income did not show evidence of interaction with GDM regarding the number of complications, the associations between GDM and both pregnancy-related and obstetric complications varied across educational attainment groups, with larger relative associations observed among women with lower education (pinteraction = 0.029 and 0.038, respectively).The associations between GDM and several adverse outcomes differed by nativity status. For example, GDM was associated with 71% higher odds of obstetric complications among Swedish-born women (OR, 1.71; 95% CI, 1.68-1.85), whereas the corresponding associations were significantly weaker among women born in Africa (1.34; 1.17-1.52) and the Eastern Mediterranean region (1.44; 1.34-1.56).However, absolute risks were not uniformly lower among foreign-born women with GDM. Notably, women born in Africa and South-East Asia had higher absolute risks of obstetric complications compared with Swedish-born without GDM.

Disparities in GDM prevalence across all three SDOH indicators underscore the importance of considering sociodemographic factors in prevention efforts. Variation in GDM-associated risks by educational level and region of birth warrant further investigation to ensure equitable care.