Jovanovič Lois, Liang Yuanjie, Weng Wayne, Hamilton Marianthe, Chen Lisa, Wintfeld Neil
Sansum Diabetes Research Institute, Santa Barbara, CA, USA.
Novo Nordisk Inc., Plainsboro, NJ, USA.
Diabetes Metab Res Rev. 2015 Oct;31(7):707-16. doi: 10.1002/dmrr.2656. Epub 2015 Jun 16.
Increasing diabetes prevalence affects a substantial number of pregnant women in the United States. Our aims were to evaluate health outcomes, medical costs, risks and types of complications associated with diabetes in pregnancy for mothers and newborns.
In this retrospective claims analysis, patients were identified from the Truven Health MarketScan(®) database (2004-2011 inclusive). Participants were aged 18-45 years, with ascertainable diabetes status [Yes/No], date of birth event >2005 and continuous health plan enrolment ≥21 months before and 3 months after the birth.
In total, 839 792 pregnancies were identified, and 66 041 (7.86%) were associated with diabetes mellitus [type 1 (T1DM), 0.13%; type 2 (T2DM), 1.21%; gestational (GDM), 6.29%; and GDM progressing to T2DM (patients without prior diabetes who had a T2DM diagnosis after the birth event), 0.23%]. Relative risk (RR) of stillbirth (2.51), miscarriage (1.28) and Caesarean section (C-section) (1.77) was significantly greater with T2DM versus non-diabetes. Risk of C-section was also significantly greater for other diabetes types [RR 1.92 (T1DM); 1.37 (GDM); 1.63 (GDM progressing to T2DM)]. Risk of overall major congenital (RR ≥ 1.17), major congenital circulatory (RR ≥ 1.19) or major congenital heart (RR ≥ 1.18) complications was greater in newborns of mothers with diabetes versus without. Mothers with T2DM had significantly higher risk (RR ≥ 1.36) of anaemia, depression, hypertension, infection, migraine, or cardiac, obstetrical or respiratory complications than non-diabetes patients. Mean medical costs were higher with all diabetes types, particularly T1DM ($27 531), than non-diabetes ($14 355).
Complications and costs of healthcare were greater with diabetes, highlighting the need to optimize diabetes management in pregnancy.
在美国，糖尿病患病率不断上升，影响着大量孕妇。我们的目的是评估妊娠糖尿病对母亲和新生儿的健康结局、医疗费用、风险及并发症类型。
在这项回顾性索赔分析中，患者来自Truven Health MarketScan®数据库（涵盖2004年至2011年）。参与者年龄在18至45岁之间，有可确定的糖尿病状态[是/否]，出生日期>2005年，且在分娩前至少连续参保21个月，分娩后连续参保3个月。
总共识别出839792例妊娠，其中66041例（7.86%）与糖尿病相关[1型糖尿病（T1DM），0.13%；2型糖尿病（T2DM），1.21%；妊娠期糖尿病（GDM），6.29%；GDM进展为T2DM（分娩后诊断为T2DM且之前无糖尿病的患者），0.23%]。与非糖尿病相比，T2DM患者的死产（相对风险[RR]为2.51）、流产（RR为1.28）和剖宫产（C-section）（RR为1.77）相对风险显著更高。其他糖尿病类型的剖宫产风险也显著更高[RR 1.92（T1DM）；1.37（GDM）；1.63（GDM进展为T2DM）]。糖尿病母亲的新生儿出现总体重大先天性（RR≥1.17）、重大先天性循环系统（RR≥1.19）或重大先天性心脏（RR≥1.18）并发症的风险更高。与非糖尿病患者相比，T2DM母亲患贫血、抑郁症、高血压、感染、偏头痛或心脏、产科或呼吸系统并发症的风险显著更高（RR≥1.36）。所有糖尿病类型的平均医疗费用均高于非糖尿病患者，尤其是T1DM（27531美元），而非糖尿病患者为14355美元。
糖尿病患者的并发症和医疗费用更高，这凸显了优化妊娠糖尿病管理的必要性。
