背景:居住在法国的孕妇中,社会心理剥夺与更早和更大的接触有关,以及母胎预后较差。我们探讨了该指标和其他两个社会经济脆弱性指标-粮食不安全和语言熟练程度差-对坚持产前护理以及孕产妇和胎儿结局的影响。
方法:在一个社会贫困的巴黎郊区,我们选择了2012年1月1日至2018年12月31日之间分娩并接受护理的女性(护士,营养师,糖尿病专家评估,建议,定期随访,以根据需要调整胰岛素剂量)妊娠高血糖。我们分析了个体社会心理剥夺之间的关联,粮食不安全,法语语言能力(通过个人问卷评估的变量)和胎儿生长(主要结果),以及其他核心母体和胎儿结局。
结果:在包括的1,168名妇女中(多种族队列,19.3%的人是欧洲人),56%,17.9%,27.5%的人有社会心理剥夺,粮食不安全,法语能力差,分别。43%的人接受了胰岛素治疗。有一个以上脆弱性的妇女有更多的糖尿病咨询。小型(SGA)的费率,适当(AGA),胎龄大(LGA)婴儿为11.4%,76.5%和12.2%,分别。这些比率在有和没有社会心理剥夺的女性中相似,以及那些有和没有粮食不安全的人。有趣的是,与熟练程度较好的女性相比,法语语言能力较差的女性分娩小于或大于胎龄儿的几率较高.
结论:我们发现法国妊娠期高血糖妇女的妊娠结局相似,无论他们是否有社会心理剥夺或粮食不安全。优化的单中心护理和专门的随访有助于减少妊娠期高血糖妇女的母婴结局不平等。
BACKGROUND: In women with hyperglycemia in pregnancy living in France, psychosocial deprivation is associated with both earlier and greater exposure to the condition, as well as poorer maternofetal prognosis. We explored the impact of this and two other socioeconomic vulnerability indicators-food insecurity and poor language proficiency-on adherence to prenatal care and maternal and fetal outcomes.
METHODS: In a socially deprived suburb of Paris, we selected women who delivered between 01/01/2012 and 31/12/2018 and received care (nurse, dietician, diabetologist evaluation, advice, regular follow-up to adjust insulin doses if requested) for hyperglycemia in pregnancy. We analyzed the associations between individual psychosocial deprivation, food insecurity, French language proficiency (variables assessed by individual questionnaires) and fetal growth (main outcome), as well as other core maternal and fetal outcomes.
RESULTS: Among the 1,168 women included (multiethnic cohort, 19.3% of whom were Europeans), 56%, 17.9%, and 27.5% had psychosocial deprivation, food insecurity, and poor French language proficiency, respectively. Forty-three percent were prescribed insulin therapy. Women with more than one vulnerability had more consultations for diabetes. The rates for small (SGA), appropriate (AGA), and large-for-gestational-age (LGA) infant were 11.4%, 76.5% and 12.2%, respectively. These rates were similar in women with and without psychosocial deprivation, and in those with and without food insecurity. Interestingly, women with poor French language proficiency had a higher odds ratio of delivering a small- or large-for-gestational age infant than those with good proficiency.
CONCLUSIONS: We found similar pregnancy outcomes for women with hyperglycemia in pregnancy living in France, irrespective of whether or not they had psychosocial deprivation or food insecurity. Optimized single-center care with specialized follow-up could contribute to reduce inequalities in maternal and fetal outcomes in women with hyperglycemia in pregnancy.