Risk of development of diabetes mellitus after diagnosis of gestational diabetes
Risk of development of diabetes mellitus after diagnosis of gestational diabetes
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DOI：
10.1503/cmaj.080012
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发表时间：
2008-07-29
影响因子：
14.6
通讯作者：
Hux, Janet E.
中科院分区：
文献类型：
--
作者：
Feig, Denice S.;Zinman, Bernard;Hux, Janet E.
背景：妊娠期糖尿病是2型糖尿病的危险因素。然而，这两个条件之间的确切关系仍然未知。我们试图确定妊娠diabetes.Methods的诊断后糖尿病的发病率：我们使用了一个人口为基础的数据库，以确定所有交付的安大略省在7年期间，从1995年4月1日至2002年3月31日。我们通过另一个管理数据库将这些分娩与被诊断为妊娠期糖尿病的母亲联系起来，该数据库根据医生服务索赔或住院记录糖尿病患者。我们检查了这些妇女从分娩到2004年3月31日的数据库记录，共9年。我们确定了糖尿病的存在，根据一个有效的管理数据库的定义，这种condition.Results：我们确定了659164名孕妇谁没有预先存在的糖尿病。其中，21 823名妇女（3.3%）被诊断为妊娠糖尿病。妊娠期糖尿病的发病率在9年的研究期间显著上升，从1995年的3.2%上升到2001年的3.6%（p <0.001）。妊娠期糖尿病后发生糖尿病的概率在分娩后9个月为3.7%，在分娩后9年为18.9%。在调整了年龄、城市或农村居住、邻里收入五分位数、妇女是否曾怀孕、妇女在指数分娩后是否患有高血压以及指数分娩前的初级保健水平后，糖尿病最重要的风险因素是指数怀孕期间患有妊娠糖尿病（风险比37.28，95%置信区间34.99 - 40.88; p <0.001）。年龄、城市居住和低收入也是重要因素。当按分娩年份进行分析时，在最新的妊娠期糖尿病妇女子队列中，糖尿病的发生率较高（1999 - 2001年期间分娩）（1995年或1996年交付）（分娩后4.7年为16%，9.0年为16%）。在这项大规模人群研究中，妊娠糖尿病后糖尿病的发生率随时间增加，9年时几乎达到20%。临床医生应利用这一估计数来协助他们为孕妇提供咨询，决策者也应利用这一估计数来针对这些妇女进行筛查和预防。
Background: It is generally appreciated that gestational diabetes is a risk factor for type 2 diabetes. However, the precise relation between these 2 conditions remains unknown. We sought to determine the incidence of diabetes mellitus after diagnosis of gestational diabetes.Methods: We used a population-based database to identify all deliveries in the province of Ontario over the 7- year period from Apr. 1, 1995, to Mar. 31, 2002. We linked these births to mothers who had been given a diagnosis of gestational diabetes through another administrative database that records people with diabetes on the basis of either physician service claims or hospital admission records. We examined database records for these women from the time of delivery until Mar. 31, 2004, a total of 9 years. We determined the presence of diabetes mellitus according to a validated administrative database definition for this condition.Results: We identified 659 164 pregnant women who had no pre- existing diabetes. Of these, 21 823 women (3.3%) had a diagnosis of gestational diabetes. The incidence of gestational diabetes rose significantly over the 9- year study period, from 3.2% in 1995 to 3.6% in 2001 (p < 0.001). The probability of diabetes developing after gestational diabetes was 3.7% at 9 months after delivery and 18.9% at 9 years after delivery. After adjustment for age, urban or rural residence, neighbourhood income quintile, whether the woman had a previous pregnancy, whether the woman had hypertension after the index delivery, and primary care level before the index delivery, the most significant risk factor for diabetes was having had gestational diabetes during the index pregnancy (hazard ratio 37.28, 95% confidence interval 34.99 - 40.88; p < 0.001). Age, urban residence and lower income were also important factors. When analyzed by year of delivery, the rate of development of diabetes was higher among the latest subcohort of women with gestational diabetes (delivery during 1999 - 2001) than among the earliest subcohort (delivery during 1995 or 1996) (16% by 4.7 years after delivery v. 16% by 9.0 years).Interpretation: In this large population- based study, the rate of development of diabetes after gestational diabetes increased over time and was almost 20% by 9 years. This estimate should be used by clinicians to assist in their counselling of pregnant women and by policy-makers to target these women for screening and prevention.