Leng Junhong, Shao Ping, Zhang Cuiping, Tian Huiguang, Zhang Fuxia, Zhang Shuang, Dong Ling, Li Lili, Yu Zhijie, Chan Juliana C N, Hu Gang, Yang Xilin
Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Women and Children's Health Centre, Tianjin, China.
Tianjin Women and Children's Health Centre, Tianjin, China.
PLoS One. 2015 Mar 23;10(3):e0121029. doi: 10.1371/journal.pone.0121029. eCollection 2015.
We compared the increases in the prevalence of gestational diabetes mellitus (GDM) based on the 1999 World Health Organization (WHO) criteria and its risk factors in Tianjin, China, over a 12-year period. We also examined the changes in the prevalence using the criteria of International Association of Diabetes and Pregnancy Study Group (IADPSG).
In 2010-2012, 18589 women who registered within 12 weeks of gestation underwent a glucose challenge test (GCT) at 24-28 gestational weeks. Amongst them, 2953 women with 1-hour plasma glucose ≥ 7.8 mmol/L underwent a 75-gram 2-hour oral glucose tolerance test (OGTT) and 781 women had a positive GCT but absented from the standard OGTT. An adjusted prevalence of GDM was calculated for the whole cohort of women by including an estimate of the proportion of women with positive GCTs who did not have OGTTs but would have been expected to have GDM. Logistic regression was used to obtain odds ratios and 95% confidence intervals using the IADPSG criteria. The prevalence of GDM risk factors was compared to the 1999 survey.
The adjusted prevalence of GDM by the 1999 WHO criteria was 8.1%, a 3.5-fold increase as in 1999. Using the IADPSG criteria increased the adjusted prevalence further to 9.3%. Advanced age, higher pre-pregnancy body mass index, Han-nationality, higher systolic blood pressure (BP), a family history of diabetes, weight gain during pregnancy and habitual smoking were risk factors for GDM. Compared to the 1999 survey, the prevalence of overweight plus obesity had increased by 1.8 folds, age ≥ 30 years by 2.3 folds, systolic BP by 2.3 mmHg over the 12-year period.
Increasing prevalence of overweight/obesity and older age at pregnancy were accompanied by increasing prevalence of GDM, further increased by change in diagnostic criteria.
我们比较了基于1999年世界卫生组织（WHO）标准的妊娠期糖尿病（GDM）患病率及其风险因素在12年期间在中国天津的增长情况。我们还使用国际糖尿病与妊娠研究组（IADPSG）的标准检查了患病率的变化。
在2010 - 2012年期间，18589名在妊娠12周内登记的妇女在妊娠24 - 28周时接受了葡萄糖耐量试验（GCT）。其中，2953名1小时血浆葡萄糖≥7.8 mmol/L的妇女接受了75克2小时口服葡萄糖耐量试验（OGTT），781名妇女GCT阳性但未参加标准OGTT。通过纳入对GCT阳性但未进行OGTT但预计会患GDM的妇女比例的估计，计算了整个队列妇女的GDM校正患病率。使用IADPSG标准，通过逻辑回归获得优势比和95%置信区间。将GDM风险因素的患病率与1999年的调查进行比较。
根据1999年WHO标准，GDM的校正患病率为8.1%，是1999年的3.5倍。使用IADPSG标准进一步将校正患病率提高到9.3%。高龄、孕前体重指数较高、汉族、收缩压较高、糖尿病家族史、孕期体重增加和习惯性吸烟是GDM的风险因素。与1999年的调查相比，在12年期间，超重加肥胖的患病率增加了1.8倍，年龄≥30岁增加了2.3倍，收缩压升高了2.3 mmHg。
超重/肥胖患病率的增加和妊娠年龄的增长伴随着GDM患病率的增加，诊断标准的改变进一步加剧了这种情况。
