The long-term effects of stillbirth on women with and without gestational diabetes: a population-based cohort study
The long-term effects of stillbirth on women with and without gestational diabetes: a population-based cohort study
复制标题
DOI：
10.1007/s00125-014-3403-9
复制
发表时间：
2015-01-01
期刊：
影响因子：
8.2
通讯作者：
Nicolucci, Antonio
中科院分区：
文献类型：
--
作者：
Pintaudi, Basilio;Lucisano, Giuseppe;Nicolucci, Antonio
目的/假设本研究的目的是估计2型糖尿病的发病率（主要目的）和因心血管事件住院（次要目的）在既往患有妊娠期糖尿病（GDM）的女性和妊娠期葡萄糖耐量正常（NGT）的女性中，并评估死胎在区分风险中的作用。基于队列研究，使用管理数据，涉及12个地方卫生当局。在2002年至2010年的指数期间，GDM女性（n = 3，851）与NGT女性（n = 11，553）进行了倾向匹配。收集2型糖尿病发展和因心血管事件住院的信息。结果在中位随访5.4年期间，2型糖尿病的发病率为每1,000人年2.1（95% CI 1.8，2.5），无GDM女性和54.0（95% CI 50.2，58.0）（发生率比[IRR] 26.9;与NGT和足月妊娠相比，95% CI 22.1，32.7）。无论GDM状态如何，死产史使2型糖尿病的风险增加约两倍。死产和GDM对2型糖尿病风险无显著交互作用，GDM与NGT相比，心血管事件风险显著增高（IRR 2.4; 95%CI 1.5，3.8）。结论/解释妊娠合并GDM和死产是决定2型糖尿病发展的重要因素。患有GDM的女性将来发生心血管事件的风险很高。妊娠合并GDM和死胎的妇女应仔细随访。
Aims/hypothesis The aim of this study was to estimate the incidence of type 2 diabetes (primary objective) and hospitalisation for cardiovascular events (secondary objective) in women with previous gestational diabetes mellitus (GDM) and in those with normal glucose tolerance (NGT) in pregnancy, and to evaluate the role of stillbirth in differentiating the risks.Methods This was a population-based cohort study using administrative data and involving 12 local health authorities. Women with GDM (n = 3,851) during the index period from 2002 to 2010 were propensity matched with women with NGT (n = 11,553). Information was collected on type 2 diabetes development and hospitalisation for cardiovascular events.Results During a median follow-up of 5.4 years, the incidence rate per 1,000 person-years of type 2 diabetes was 2.1 (95% CI 1.8, 2.5) in women without GDM and 54.0 (95% CI 50.2, 58.0) among women with GDM and pregnancy at term (incidence rate ratio [IRR] 26.9; 95% CI 22.1, 32.7 compared with NGT and pregnancy at term). A history of stillbirth increased the risk of type 2 diabetes development by about twofold, irrespective of GDM status. No significant interaction between stillbirth and GDM on type 2 diabetes risk was found. GDM was associated with a significantly higher risk of cardiovascular events compared with NGT (IRR 2.4; 95% CI 1.5, 3.8).Conclusions/interpretation Pregnancy complicated by GDM and ending in stillbirth represents an important contributory factor in determining type 2 diabetes development. Women with GDM are at a high risk of future cardiovascular events. Women with pregnancy complicated by GDM and stillbirth deserve careful follow-up.