Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996-2010
Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996-2010
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DOI：
10.2337/dc13-2717
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发表时间：
2014-06-01
期刊：
影响因子：
16.2
通讯作者：
Lipscombe, Lorraine L.
中科院分区：
文献类型：
--
作者：
Feig, Denice S.;Hwee, Jeremiah;Lipscombe, Lorraine L.
妊娠期糖尿病妇女有很高的妊娠并发症发生率。我们的目的是探讨糖尿病的发病率在怀孕期间的趋势，并检查是否有严重的围产期outcomes的风险已经changed.RESEARCH设计和METHODS我们进行了一项基于人口的队列研究，1,109,605名妇女谁交付在加拿大安大略，1996年4月1日至2010年3月31日。我们将女性分为妊娠糖尿病（GDM）（n = 45，384）、妊娠前糖尿病（pre-GDM）（n = 13，278）或无糖尿病（n = 1，050，943）。计算妊娠期糖尿病的年年龄调整率，并使用Poisson回归分析比较各组之间和各年的严重围产儿结局率。从1996年到2010年，GDM（2.7- 5.6%，P < 0.001）和GDM前期（0.7- 1.5%，P < 0.001）的年龄调整率均翻了一番。先天畸形率下降了23%，而围产期死亡率没有显著变化。然而，与无糖尿病的妇女相比，患有GDM前和GDM的妇女面临先天性异常的风险增加（相对风险分别为1.86 [95% CI 1.49-2.33]和1.26 [1.09-1.45]），GDM前期妇女的围产期死亡率仍然升高（2.33 [1.59-3.43]）.结论妊娠期GDM和GDM前期的发病率在过去的14年中翻了一番，妊娠期糖尿病对社会的总体负担正在增加。虽然糖尿病妇女的先天畸形率有所下降，但围产期死亡率保持不变，与非糖尿病妇女相比，两者的风险仍然显着升高。需要加大努力，减少这些不利后果。
OBJECTIVEWomen with diabetes in pregnancy have high rates of pregnancy complications. Our aims were to explore trends in the incidence of diabetes in pregnancy and examine whether the risk of serious perinatal outcomes has changed.RESEARCH DESIGN AND METHODSWe performed a population-based cohort study of 1,109,605 women who delivered in Ontario, Canada, between 1 April 1996 and 31 March 2010. We categorized women as gestational diabetes (GDM) (n = 45,384), pregestational diabetes (pre-GDM) (n = 13,278), or no diabetes (n = 1,050,943). The annual age-adjusted rates of diabetes in pregnancy were calculated, and rates of serious perinatal outcomes were compared between groups and by year using Poisson regression.RESULTSThe age-adjusted rate of both GDM (2.7-5.6%, P < 0.001) and pre-GDM (0.7-1.5%, P < 0.001) doubled from 1996 to 2010. The rate of congenital anomalies declined by 23%, whereas the rate of perinatal mortality did not change significantly. However, compared with women with no diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (relative risk 1.86 [95% CI 1.49-2.33] and 1.26 [1.09-1.45], respectively), and perinatal mortality remained elevated in women with pre-GDM (2.33 [1.59-3.43]).CONCLUSIONSThe incidence of both GDM and pre-GDM in pregnancy has doubled over the last 14 years, and the overall burden of diabetes in pregnancy on society is growing. Although congenital anomaly rates have declined in women with diabetes, perinatal mortality rates remain unchanged, and the risk of both remains significantly elevated compared with nondiabetic women. Increased efforts are needed to reduce these adverse outcomes.