Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada.
College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Can J Diabetes. 2018 Feb;42(1):71-77. doi: 10.1016/j.jcjd.2017.04.003. Epub 2017 Jun 2.
To explore associations among prenatal, obstetric and perinatal factors and the development of childhood-onset type 2 diabetes.
This retrospective, case-control study utilized administrative data housed at the Manitoba Centre for Health Policy. De-identified health records were examined from a sample of 270 children (aged 10 to 17 years at time of diagnosis) with type 2 diabetes and 1341 children without type 2 diabetes matched for age, sex and geographic location. Patients and control subjects were linked to their de-identified biological mothers' health records. Prenatal, obstetric and perinatal factors were investigated. Univariate and multivariable conditional regression analyses were conducted to identify key factors associated with the development of type 2 diabetes in children.
The mean age at diagnosis was 13.1 years, and 61% of patients were girls. The majority (71.1%) of children with type 2 diabetes resided in rural areas. Exposure to maternal pregestational diabetes increased the odds of childhood-onset type 2 diabetes nearly 6-fold, and exposure to gestational diabetes carried a 4-fold increased risk. Breastfeeding was found to be protective, decreasing the risk of childhood-onset type 2 diabetes (odds ratio = 0.52, 95% confidence interval = 0.36-0.74). Low maternal income was significantly associated with development of childhood-onset type 2 diabetes (odds ratio = 6.67, 95% confidence interval = 3.01-14.79).
Health and social policies and programs are needed to provide financial, educational and clinical resources that target women whose pregnancies are affected by poverty, type 2 diabetes or gestational diabetes. Breastfeeding should be encouraged to aid in the prevention of childhood-onset type 2 diabetes.
探讨产前、产科和围产期因素与儿童期 2 型糖尿病发病的关系。
本回顾性病例对照研究利用马尼托巴省卫生政策中心的行政数据进行。从 270 名（诊断时年龄为 10-17 岁）儿童 2 型糖尿病患者和 1341 名年龄、性别和地理位置匹配的无 2 型糖尿病儿童的匿名健康记录中抽取样本进行检查。将患者和对照对象与其匿名生物母亲的健康记录相联系。研究了产前、产科和围产期因素。进行了单变量和多变量条件回归分析，以确定与儿童 2 型糖尿病发病相关的关键因素。
诊断时的平均年龄为 13.1 岁，61%的患者为女性。大多数（71.1%）儿童 2 型糖尿病患者居住在农村地区。母亲孕前糖尿病的暴露使儿童期 2 型糖尿病的发病几率增加近 6 倍，而妊娠期糖尿病的暴露则使发病风险增加 4 倍。母乳喂养被发现具有保护作用，可降低儿童期 2 型糖尿病的发病风险（比值比=0.52，95%置信区间=0.36-0.74）。母亲收入低与儿童期 2 型糖尿病的发生显著相关（比值比=6.67，95%置信区间=3.01-14.79）。
需要制定卫生和社会政策及方案，提供针对受贫困、2 型糖尿病或妊娠期糖尿病影响的孕妇的财政、教育和临床资源。应鼓励母乳喂养，以帮助预防儿童期 2 型糖尿病。
