Department of Medicine, University of Toronto, Toronto, Ontario, CanadaInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, CanadaInstitute for Clinical Evaluative Sciences, Toronto, Ontario, CanadaDepartment of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, CanadaDivision of Endocrinology and Metabolism, Mount Sinai Hospital, Toronto, Ontario, Canada
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Diabetes Care. 2014 Jun;37(6):1590-6. doi: 10.2337/dc13-2717. Epub 2014 Apr 4.
Women 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.
We 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.
The 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]).
The 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.
患有妊娠糖尿病的女性妊娠并发症发生率较高。我们旨在探讨妊娠糖尿病发病率的变化趋势，并研究严重围产期结局的风险是否发生变化。
我们对 1996 年 4 月 1 日至 2010 年 3 月 31 日期间在加拿大安大略省分娩的 1109605 名女性进行了一项基于人群的队列研究。我们将女性分为妊娠糖尿病（GDM）（n=45384）、孕前糖尿病（pre-GDM）（n=13278）和无糖尿病（n=1050943）。计算了妊娠糖尿病的年年龄调整发病率，并使用泊松回归比较了各组之间和各年份之间严重围产期结局的发生率。
GDM（2.7-5.6%，P<0.001）和 pre-GDM（0.7-1.5%，P<0.001）的年龄调整发病率从 1996 年到 2010 年翻了一番。先天性异常的发生率下降了 23%，而围产儿死亡率没有显著变化。然而，与无糖尿病的女性相比，患有 pre-GDM 和 GDM 的女性发生先天性异常的风险增加（相对风险 1.86 [95%CI 1.49-2.33]和 1.26 [1.09-1.45]），pre-GDM 女性的围产儿死亡率仍然升高（2.33 [1.59-3.43]）。
在过去的 14 年中，妊娠 GDM 和 pre-GDM 的发病率翻了一番，糖尿病妊娠对社会的整体负担正在增加。尽管糖尿病女性的先天性异常发生率有所下降，但围产儿死亡率保持不变，与非糖尿病女性相比，这两种疾病的风险仍然显著升高。需要加大力度降低这些不良结局。
