Getahun Darios, Nath Carl, Ananth Cande V, Chavez Martin R, Smulian John C
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, USA.
Am J Obstet Gynecol. 2008 May;198(5):525.e1-5. doi: 10.1016/j.ajog.2007.11.017. Epub 2008 Feb 15.
The objective of the study was to characterize trends in gestational diabetes (GDM) by maternal age, race, and geographic region in the United States.
The National Hospital Discharge Survey, comprised of births in the United States between 1989 and 2004 (weighted n = 58,922,266), was used to examine trends in GDM, based on an International Classification of Diseases, Ninth Revision, Clinical Modification code of 648.8. We examined temporal trends by comparing GDM rates in the earliest (1989-1990) vs most recent (2003-2004) biennial periods. Relative risks, quantifying racial disparity (black vs white) in GDM, were derived through logistic regression models after adjusting for confounders. These analyses were further stratified by maternal age and geographic region.
Prevalence rates of GDM increased from 1.9% in 1989-1990 to 4.2% in 2003-2004, a relative increase of 122% (95% confidence interval [CI] 120%, 124%). Among whites, GDM increased from 2.2% in 1989-1990 to 4.2% in 2003-2004 (relative increase of 94% [95% CI 91%, 96%]), and this was largely driven by an increase in the 25-34 year age group. In contrast, the largest relative increase in GDM (260% [95% CI 243%, 279%]) among blacks between 1989-1990 (0.6%) and 2003-2004 (2.1%) occurred to women aged younger than 25 years. The black-white disparity in GDM rates widened markedly among women aged younger than 35 years in the 1997-2004 periods. The largest relative increases were seen in the West (182% [95% CI 177%, 187%]) followed by the South and Northeast. The observed increase in GDM rates in the Northeast, Midwest, and South regions most likely is due to increase in GDM prevalence rates among blacks.
This study shows that the prevalence rate of GDM in the United States has increased dramatically between 1989 and 2004. The temporal increase and the widening black-white disparity in the rate of GDM deserves further investigation.
本研究的目的是描述美国妊娠期糖尿病（GDM）在产妇年龄、种族和地理区域方面的趋势。
采用1989年至2004年美国出生情况的全国医院出院调查（加权n = 58,922,266），根据国际疾病分类第九版临床修订本代码648.8来研究GDM的趋势。我们通过比较最早（1989 - 1990年）与最近（2003 - 2004年）两年期的GDM发病率来研究时间趋势。在调整混杂因素后，通过逻辑回归模型得出量化GDM种族差异（黑人与白人）的相对风险。这些分析进一步按产妇年龄和地理区域分层。
GDM的患病率从1989 - 1990年的1.9%上升至2003 - 2004年的4.2%，相对增长122%（95%置信区间[CI] 120%，124%）。在白人中，GDM从1989 - 199年的2.2%升至2003 - 2004年的4.2%（相对增长94% [95% CI 91%，96%]），这主要是由25 - 34岁年龄组的增长推动的。相比之下，黑人中GDM在1989 - 1990年（0.6%）至2003 - 2004年（2.1%）期间最大的相对增长（260% [95% CI 243%，279%]）出现在年龄小于25岁的女性中。在1997 - 2004年期间，35岁以下女性中GDM发病率的黑白差异显著扩大。相对增长最大的是西部（182% [95% CI 177%，187%]），其次是南部和东北部。在东北部、中西部和南部地区观察到的GDM发病率增加很可能是由于黑人中GDM患病率的增加。
本研究表明，1989年至2004年期间美国GDM的患病率急剧上升。GDM发病率的时间增长以及黑白差异的扩大值得进一步研究。
