Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review.

Background: Ethnic minorities in Europe have high susceptibility to type 2 diabetes (T2DM) and, in some groups, also cardiovascular disease (CVD). Pregnancy can be considered a stress test that predicts future morbidity patterns in women and that affects future health of the child. Objective: To review ethnic differences in: 1) adiposity, hyperglycaemia, and pre-eclampsia during pregnancy; 2) future risk in the mother of obesity, T2DM and CVD; and 3) prenatal development and possible influences of maternal obesity, hyperglycaemia, and pre-eclampsia on offspring’s future disease risk, as relevant for ethnic minorities in Europe of Asian and African origin. Design: Literature review. Results: Maternal health among ethnic minorities is still sparsely documented. Higher pre-pregnant body mass index (BMI) is found in women of African and Middle Eastern descent, and lower BMI in women from East and South Asia compared with women from the majority population. Within study populations, risk of gestational diabetes mellitus (GDM) is considerably higher in many minority groups, particularly South Asians, than in the majority population. This increased risk is apparent at lower BMI and younger ages. Women of African origin have higher risk of pre-eclampsia. A GDM pregnancy implies approximately seven-fold higher risk of T2DM than normal pregnancies, and both GDM and pre-eclampsia increase later risk of CVD. Asian neonates have lower birth weights, and mostly also African neonates. This may translate into increased risks of later obesity, T2DM, and CVD. Foetal overgrowth can promote the same conditions. Breastfeeding represents a possible strategy to reduce risk of T2DM in both the mother and the child. Conclusions: Ethnic minority women in Europe with Asian and African origin and their offspring seem to be at increased risk of T2DM and CVD, both currently and in the future. Pregnancy is an important window of opportunity for short and long-term disease prevention

Breastfeeding support: What works? A population-based pragmatic trial and a multi-ethnic cohort study

Although the breastfeeding prevalence is higher in Norway than in most other high-income countries, there is a gap between recommendations and current breastfeeding practice. The aims of this thesis were to assess the effectiveness of the Baby-Friendly community health services on breastfeeding and maternal satisfaction in a pragmatic trial in 54 municipalities. Socioeconomic inequalities in breastfeeding have persisted in Norway for several decades. Therefore, we conducted an observational study nested within the trial to explore whether socioeconomic inequalities in exclusive breastfeeding could be explained by established determinants of breastfeeding. Furthermore, we investigated inequalities in breastfeeding related to gestational diabetes and ethnic origin, using data from the Stork Groruddalen cohort. Women in the intervention group were more likely to exclusively breastfeed compared to those who received routine care: 17.9% vs 14.1% until 6 months (cluster adjusted odds ratio 1.33; 95% confidence interval (CI) 1.03 to 1.72). The intervention had no effect on breastfeeding until 12 months. Maternal satisfaction with the breastfeeding experience did not differ, neither did perceived breastfeeding pressure. We observed that socioeconomic inequalities in exclusive breastfeeding were largely explained by other sociodemographic factors, smoking habits and breastfeeding difficulties. In the Stork Groruddalen cohort it has been found that women with an origin from South Asia and the Middle East were much more likely to be diagnosed with gestational diabetes than women from Western Europe. It has previously been shown that breastfeeding may reduce the risk of type 2 diabetes in mothers with recent gestational diabetes. We found that gestational diabetes was associated with earlier cessation of predominant breastfeeding: (adjusted hazard ratio 1.33, 95% CI 1.01 to 1.77). Women with an origin from South Asia and the Middle East ended predominant breastfeeding earlier than Western European women. The Baby-friendly community health services had a significant impact on exclusive breastfeeding. As a supplement to this population-based intervention, targeted approaches may be necessary to reduce inequalities in breastfeeding related to socioeconomic position, ethnic origin and gestational diabetes

Recent gestational diabetes was associated with mothers stopping predominant breastfeeding earlier in a multi-ethnic population

Aim: It has previously been shown that breastfeeding may reduce the risk of type 2 diabetes in mothers with recent gestational diabetes mellitus (GDM). This study compared the cessation of predominant breastfeeding in mothers with and without recent GDM in a multi‐ethnic population. Methods: From May 2008 to May 2010, healthy pregnant women attending antenatal care provided by community health services in Eastern Oslo, Norway were recruited. We included 616 women–58% non‐Western–and interviewed and examined them at a mean of 15 and 28 weeks of gestation and 14 weeks’ postpartum. Cox regression models examined the association between GDM, as assessed by the 2013 World Health Organization criteria, and breastfeeding cessation. Results: Overall, 190 of the 616 (31%) mothers had GDM and they ended predominant breastfeeding earlier than mothers without GDM, with an adjusted hazard ratio (aHR) of 1.33 and 95% confidence interval (95% CI) of 1.01–1.77. Mothers of South Asian origin ended predominant breastfeeding earlier than Western European mothers in the adjusted analysis (aHR 1.53, 95% CI: 1.04–2.25), but Middle Eastern mothers did not. Conclusion: Recent gestational diabetes was associated with earlier cessation of predominant breastfeeding in Western European and non‐Western women

Questioning the ethics of international research on formula milk supplementation in low-income African countries: response

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